Provider Demographics
NPI:1376160457
Name:NORTH CANYON MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:NORTH CANYON MEDICAL CENTER, INC
Other - Org Name:NORTH CANYON JEROME CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-934-9695
Mailing Address - Street 1:267 N CANYON DR
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330-5500
Mailing Address - Country:US
Mailing Address - Phone:208-934-4433
Mailing Address - Fax:208-934-8643
Practice Address - Street 1:491 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-6701
Practice Address - Country:US
Practice Address - Phone:208-644-7500
Practice Address - Fax:208-644-7501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH CANYON MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-06
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health