Provider Demographics
NPI:1598825028
Name:CARIBOU MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CARIBOU MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOPES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-547-3341
Mailing Address - Street 1:300 S 3RD W
Mailing Address - Street 2:
Mailing Address - City:SODA SPRINGS
Mailing Address - State:ID
Mailing Address - Zip Code:83276-1559
Mailing Address - Country:US
Mailing Address - Phone:208-547-3341
Mailing Address - Fax:208-547-2790
Practice Address - Street 1:300 S 3RD W
Practice Address - Street 2:
Practice Address - City:SODA SPRINGS
Practice Address - State:ID
Practice Address - Zip Code:83276-1559
Practice Address - Country:US
Practice Address - Phone:208-547-3341
Practice Address - Fax:208-547-2790
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARIBOU MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-12
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID37275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID13Z309Medicare Oscar/Certification