Provider Demographics
NPI:1184620791
Name:ELMORE MEDICAL CENTER HOSPITAL DISTRICT
Entity type:Organization
Organization Name:ELMORE MEDICAL CENTER HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SENGER
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:208-587-8401
Mailing Address - Street 1:895 N 6TH E
Mailing Address - Street 2:PO BOX 1270
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-2207
Mailing Address - Country:US
Mailing Address - Phone:208-587-8401
Mailing Address - Fax:208-580-2685
Practice Address - Street 1:895 N 6TH E
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-2207
Practice Address - Country:US
Practice Address - Phone:208-587-8401
Practice Address - Fax:208-580-2685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDH5314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID135006Medicare ID - Type UnspecifiedMEDICARE ID