Provider Demographics
NPI:1386632180
Name:BENEWAH COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:BENEWAH COMMUNITY HOSPITAL
Other - Org Name:ST MARIES FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MINIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-245-5551
Mailing Address - Street 1:229 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ST MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-1803
Mailing Address - Country:US
Mailing Address - Phone:208-245-2591
Mailing Address - Fax:208-245-5246
Practice Address - Street 1:229 S 8TH ST
Practice Address - Street 2:
Practice Address - City:ST MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-1813
Practice Address - Country:US
Practice Address - Phone:208-245-2591
Practice Address - Fax:208-245-5246
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENEWAH COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-06
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010006182OtherREGENCE BS OF ID
MT358889400Medicaid
ID806390700Medicaid
WA7051733Medicaid
WA0040690OtherDEPT LABOR & INDUSTRIES
ID10008OtherSTATE INSURANCE FUND
ID87809OtherBLUE CROSS OF ID
ID002865900Medicaid
WA0040690OtherDEPT LABOR & INDUSTRIES
ID0595810002Medicare NSC
ID87809OtherBLUE CROSS OF ID
ID000010006182OtherREGENCE BS OF ID