Provider Demographics
NPI:1558637017
Name:ST. JOSEPH REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:ST. JOSEPH REGIONAL MEDICAL CENTER
Other - Org Name:ST. JOSEPH MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-799-5696
Mailing Address - Street 1:341 SAINT JOHNS WAY
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2436
Mailing Address - Country:US
Mailing Address - Phone:208-743-2511
Mailing Address - Fax:208-799-5528
Practice Address - Street 1:341 SAINT JOHNS WAY
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2436
Practice Address - Country:US
Practice Address - Phone:208-743-2511
Practice Address - Fax:208-799-5528
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JOSEPH REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-29
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID130003Medicare Oscar/Certification