Provider Demographics
NPI:1912555319
Name:MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.
Entity Type:Organization
Organization Name:MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.
Other - Org Name:SAINT ALPHONSUS HEALTH PLAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE COUNSEL
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHETSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:614-546-4651
Mailing Address - Street 1:6150 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1574
Mailing Address - Country:US
Mailing Address - Phone:614-546-4651
Mailing Address - Fax:614-546-4106
Practice Address - Street 1:3100 EASTON SQUARE PLACE
Practice Address - Street 2:SUITE 300 - HEALTH PLAN
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219
Practice Address - Country:US
Practice Address - Phone:614-546-4651
Practice Address - Fax:614-546-4106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-28
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization