Provider Demographics
NPI:1760823397
Name:SAINT ALPHONSUS MEDICAL CENTER- ONTARIO INC
Entity Type:Organization
Organization Name:SAINT ALPHONSUS MEDICAL CENTER- ONTARIO INC
Other - Org Name:SAINT ALPHONSUS MEDICAL GROUP FRUITLAND HEALTH PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LANNIE
Authorized Official - Last Name:CHECKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-367-7347
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-6275
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:910 NW 16TH ST
Practice Address - Street 2:STE 101
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2265
Practice Address - Country:US
Practice Address - Phone:208-452-6851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT ALPHONSUS MEDICAL CENTER ONTARIO INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-11
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health