Provider Demographics
NPI:1417252719
Name:SYRINGA GENERAL HOSPITAL DISTRICT CIF
Entity Type:Organization
Organization Name:SYRINGA GENERAL HOSPITAL DISTRICT CIF
Other - Org Name:SYRINGA HOSPITAL SWINGBED
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-983-1700
Mailing Address - Street 1:607 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GRANGEVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83530
Mailing Address - Country:US
Mailing Address - Phone:208-983-1700
Mailing Address - Fax:208-983-2114
Practice Address - Street 1:607 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:GRANGEVILLE
Practice Address - State:ID
Practice Address - Zip Code:83530
Practice Address - Country:US
Practice Address - Phone:208-983-1700
Practice Address - Fax:208-983-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID18275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID13Z315Medicare Oscar/Certification