Provider Demographics
NPI:1558679951
Name:NORTH CANYON MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:NORTH CANYON MEDICAL CENTER, INC
Other - Org Name:NORTH CANYON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATIENT FINANCIAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-934-4433
Mailing Address - Street 1:267 N CANYON DR
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330-5500
Mailing Address - Country:US
Mailing Address - Phone:208-934-4433
Mailing Address - Fax:
Practice Address - Street 1:267 N CANYON DR
Practice Address - Street 2:
Practice Address - City:GOODING
Practice Address - State:ID
Practice Address - Zip Code:83330-5500
Practice Address - Country:US
Practice Address - Phone:208-934-4433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIAGNOSTIC IMAGING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-20
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID174400000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1609046671Medicaid