Provider Demographics
NPI:1710041785
Name:ONEIDA COUNTY HOSPITAL
Entity Type:Organization
Organization Name:ONEIDA COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:V
Authorized Official - Last Name:WINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-766-2231
Mailing Address - Street 1:220 BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:MALAD CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83252-1256
Mailing Address - Country:US
Mailing Address - Phone:208-766-2600
Mailing Address - Fax:208-766-4258
Practice Address - Street 1:220 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:MALAD CITY
Practice Address - State:ID
Practice Address - Zip Code:83252-1256
Practice Address - Country:US
Practice Address - Phone:208-766-2600
Practice Address - Fax:208-766-4258
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONEIDA COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-21
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID138509261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1265482905Medicaid
ID1265482905Medicaid
ID138509Medicare Oscar/Certification