Provider Demographics
NPI:1922182278
Name:STEELE MEMORIAL MEDICAL CENTER
Entity Type:Organization
Organization Name:STEELE MEMORIAL MEDICAL CENTER
Other - Org Name:STEELE MEMORIAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ABNER
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-756-5720
Mailing Address - Street 1:805 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467
Mailing Address - Country:US
Mailing Address - Phone:208-756-6212
Mailing Address - Fax:208-756-6336
Practice Address - Street 1:805 MAIN ST.
Practice Address - Street 2:
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467
Practice Address - Country:US
Practice Address - Phone:208-756-6212
Practice Address - Fax:208-756-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID133996261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806644700Medicaid
ID133996Medicare Oscar/Certification
ID806644700Medicaid