Provider Demographics
NPI:1609046671
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:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-934-9695
Mailing Address - Street 1:267 NORTH CANYON DRIVE
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330
Mailing Address - Country:US
Mailing Address - Phone:208-934-4433
Mailing Address - Fax:208-934-8643
Practice Address - Street 1:267 NORTH CANYON DRIVE
Practice Address - Street 2:
Practice Address - City:GOODING
Practice Address - State:ID
Practice Address - Zip Code:83330-1858
Practice Address - Country:US
Practice Address - Phone:208-934-4433
Practice Address - Fax:208-934-8643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID19282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010166504OtherREGENCE BLUE SHIELD EMERENCY ROOM
ID1609046671OtherNORTH CANYON MEDICAL CENTER
ID805657700OtherMEDICAID LIFELINE
ID000010166495OtherREGENCE BLUE SHIELD
ID002856400Medicaid
ID1518377019OtherGOODING FAMILY PHYSICIANS
185627500OtherDEPT OF LABOR
ID1952716540OtherJENNIFER PARSONS
ID614134000OtherDEPARTMENT OF LABOR
ID805694900OtherMEDICAID EMERGENCY ROOM
ID131302OtherMEDICARE
ID808314000Medicaid
TN1252103OtherCIGNA GOVERNMENT
ID1285925602OtherJENNIFER OLSEN
ID131302OtherMEDICARE BILLING NUMBER
ID133819Medicare PIN
ID805694900OtherMEDICAID EMERGENCY ROOM
185627500OtherDEPT OF LABOR
ID002856400Medicaid
ID138520Medicare Oscar/Certification
6138960001Medicare NSC
ID1518377019OtherGOODING FAMILY PHYSICIANS
ID805657700OtherMEDICAID LIFELINE