Provider Demographics
NPI:1386636355
Name:SAINT ALPHONSUS MEDICAL CENTER BAKER CITY, INC
Entity Type:Organization
Organization Name:SAINT ALPHONSUS MEDICAL CENTER BAKER CITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LANNIE
Authorized Official - Last Name:CHECKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-367-7347
Mailing Address - Street 1:3325 POCAHONTAS RD
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-1464
Mailing Address - Country:US
Mailing Address - Phone:541-523-6461
Mailing Address - Fax:541-523-8151
Practice Address - Street 1:3325 POCAHONTAS RD
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1464
Practice Address - Country:US
Practice Address - Phone:541-523-6461
Practice Address - Fax:541-523-8151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR809590Medicaid
OR150232Medicaid
OR500619115Medicaid
OR178061Medicaid
OR38-Z315Medicare Oscar/Certification
OR809590Medicaid
OR0000ZGBGNMedicare PIN
OR0000WFBTDMedicare PIN