Provider Demographics
NPI:1487858023
Name:SAINT ALPHONSUS PHYSICIAN SERVICES INC
Entity Type:Organization
Organization Name:SAINT ALPHONSUS PHYSICIAN SERVICES INC
Other - Org Name:SAINT ALPHONSUS MEDICAL GROUP IOWA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRAHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-367-7939
Mailing Address - Street 1:315 EAST ELM STREET
Mailing Address - Street 2:SUITE 20
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4881
Mailing Address - Country:US
Mailing Address - Phone:208-453-3383
Mailing Address - Fax:208-453-3290
Practice Address - Street 1:211 W IOWA AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-2834
Practice Address - Country:US
Practice Address - Phone:208-465-7377
Practice Address - Fax:208-465-7397
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT ALPHONSUS PHYSICIAN SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-14
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID133825Medicare Oscar/Certification