Provider Demographics
| NPI: | 1861676298 |
|---|---|
| Name: | SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC |
| Entity Type: | Organization |
| Organization Name: | SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC |
| Other - Org Name: | |
| Other - Org Type: | |
| 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: | 208-367-5170 |
| Mailing Address - Fax: | 208-367-5180 |
| Practice Address - Street 1: | 315 E ELM ST |
| Practice Address - Street 2: | STE 100 |
| Practice Address - City: | CALDWELL |
| Practice Address - State: | ID |
| Practice Address - Zip Code: | 83605 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 208-459-7415 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-12-20 |
| Last Update Date: | 2023-01-24 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 367A00000X | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| ID | 806290700 | Medicaid | |
| ID | 1250806 | Medicare PIN |
