Provider Demographics
NPI:1891891792
Name:SAINT ALPHONSUS MEDICAL CENTER- ONTARIO INC
Entity Type:Organization
Organization Name:SAINT ALPHONSUS MEDICAL CENTER- ONTARIO INC
Other - Org Name:SAINT ALPHONSUS MEDICAL CENTER ONTARIO
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 1:351 SW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2639
Mailing Address - Country:US
Mailing Address - Phone:541-881-7373
Mailing Address - Fax:541-881-7186
Practice Address - Street 1:351 SW 9TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2639
Practice Address - Country:US
Practice Address - Phone:541-881-7373
Practice Address - Fax:541-881-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14-1470282N00000X
ORRP00008023336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR003346500Medicaid
3813082OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3813082OtherNCPDP PROVIDER IDENTIFICATION NUMBER
100399Medicare Oscar/Certification