Provider Demographics
NPI:1407563265
Name:STEELE MEMORIAL MEDICAL CENTER
Entity Type:Organization
Organization Name:STEELE MEMORIAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-756-5616
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-0700
Mailing Address - Country:US
Mailing Address - Phone:208-756-5698
Mailing Address - Fax:208-756-5826
Practice Address - Street 1:805 MAIN ST
Practice Address - Street 2:
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-4316
Practice Address - Country:US
Practice Address - Phone:208-756-6212
Practice Address - Fax:208-756-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID00356OtherCLINIC-BLUE CROSS
ID1254505Medicaid
ID133996OtherMEDICAID-CLINIC
ID8D145OtherBLUE CROSS