Provider Demographics
NPI:1750336608
Name:SYRINGA GENERAL HOSPITAL DISTRICT C I F
Entity type:Organization
Organization Name:SYRINGA GENERAL HOSPITAL DISTRICT C I F
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:APPLEWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-983-1700
Mailing Address - Street 1:607 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRANGEVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83530-1345
Mailing Address - Country:US
Mailing Address - Phone:208-983-1700
Mailing Address - Fax:
Practice Address - Street 1:607 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GRANGEVILLE
Practice Address - State:ID
Practice Address - Zip Code:83530-1345
Practice Address - Country:US
Practice Address - Phone:208-983-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID72083416L0300X
ID18282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002438100Medicaid
ID83642OtherPRO FEE BLUE CROSS OF ID
ID00299OtherBLUE CROSS OF IDAHO
ID000010006515OtherREGENCE BLUE SHIELD OF ID
ID131315Medicare Oscar/Certification
ID000010006515OtherREGENCE BLUE SHIELD OF ID
ID1252305Medicare ID - Type UnspecifiedPRO FEE CIGNA MEDICARE #