Provider Demographics
NPI:1518962273
Name:ELMORE MEDICAL CENTER HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:ELMORE MEDICAL CENTER HOSPITAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-587-8401
Mailing Address - Street 1:895 NORTH 6TH EAST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647
Mailing Address - Country:US
Mailing Address - Phone:208-587-8401
Mailing Address - Fax:208-587-8406
Practice Address - Street 1:895 NORTH 6TH EAST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647
Practice Address - Country:US
Practice Address - Phone:208-587-8401
Practice Address - Fax:208-587-8406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010148578OtherBLUE SHIELD
ID002860700Medicaid
ID13Z311OtherMEDICARE SWING BED
ID8K594OtherBLUE CROSS PROF NUMBER
ID000010149755OtherBLUE SHIELD PROF NUMBER
ID00406OtherBLUE CROSS
ID807044000OtherMEDICAID PROFESSIONAL FEE
ID8K594OtherBLUE CROSS PROF NUMBER
ID000010148578OtherBLUE SHIELD