Provider Demographics
NPI:1649962671
Name:NORTH CANYON MEDICAL CENTER INC.
Entity type:Organization
Organization Name:NORTH CANYON MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:J'DEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:208-934-4433
Mailing Address - Street 1:267 N CANYON DR
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330-5500
Mailing Address - Country:US
Mailing Address - Phone:208-934-4433
Mailing Address - Fax:
Practice Address - Street 1:426 PARKVIEW LOOP E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301
Practice Address - Country:US
Practice Address - Phone:208-934-4433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH CANYON MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty