Provider Demographics
NPI:1447208947
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:JAMES
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:ANGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-814-1000
Mailing Address - Street 1:PO BOX 409
Mailing Address - Street 2:650 ADDISON AVE WEST
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-0409
Mailing Address - Country:US
Mailing Address - Phone:208-814-7459
Mailing Address - Fax:208-814-7491
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:208-814-7459
Practice Address - Fax:208-814-7491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital