Provider Demographics
NPI:1760506851
Name:ELMORE MEDICAL CENTER HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:ELMORE MEDICAL CENTER HOSPITAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:JANOUSEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-587-8401
Mailing Address - Street 1:895 N 6TH E
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-2207
Mailing Address - Country:US
Mailing Address - Phone:208-587-8401
Mailing Address - Fax:208-587-8406
Practice Address - Street 1:895 N 6TH E
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-2207
Practice Address - Country:US
Practice Address - Phone:208-587-8401
Practice Address - Fax:208-587-8406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807044000Medicaid
ID8K594OtherEMC RADIOLOGY GROUP
ID000010148578OtherEMC RADIOLOGY GROUP
ID807044000Medicaid