Provider Demographics
NPI:1508989765
Name:BINGHAM MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BINGHAM MEMORIAL HOSPITAL
Other - Org Name:BINGHAM MEMORIAL PHYSICIANS AND SURGEONS CLINIC OF SHELLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAML
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-785-3801
Mailing Address - Street 1:275 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:SHELLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83274-1230
Mailing Address - Country:US
Mailing Address - Phone:208-785-4100
Mailing Address - Fax:
Practice Address - Street 1:275 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:SHELLEY
Practice Address - State:ID
Practice Address - Zip Code:83274-1230
Practice Address - Country:US
Practice Address - Phone:208-785-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health