Provider Demographics
NPI:1407853344
Name:MAGIC VALLEY REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:MAGIC VALLEY REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-737-2103
Mailing Address - Street 1:PO BOX 409
Mailing Address - Street 2:650 ADDISON AVE W
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-0409
Mailing Address - Country:US
Mailing Address - Phone:208-732-3000
Mailing Address - Fax:208-732-3220
Practice Address - Street 1:650 ADDISON AVE W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5444
Practice Address - Country:US
Practice Address - Phone:208-732-3000
Practice Address - Fax:208-732-3220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID14282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID02576OtherBLUE CROSS OF IDAHO
ID01958OtherBLUE CROSS OF IDAHO
ID8K198OtherBLUE CROSS OF IDAHO
ID03269OtherBLUE CROSS OF IDAHO
ID000010006647OtherBLUE SHIELD
ID000010006673OtherBLUE SHIELD
ID000010006672OtherBLUE SHIELD
ID00018OtherBLUE CROSS
ID8C535OtherBLUE CROSS OF IDAHO
ID000010006646OtherBLUE SHIELD
ID000010006649OtherBLUE SHIELD
ID02576OtherBLUE CROSS OF IDAHO
ID000010006646OtherBLUE SHIELD
ID130002Medicare ID - Type UnspecifiedPROVIDER NUMBER