Provider Demographics
NPI:1912998261
Name:CARIBOU MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CARIBOU MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOPES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-547-3341
Mailing Address - Street 1:300 S 3RD W
Mailing Address - Street 2:
Mailing Address - City:SODA SPRINGS
Mailing Address - State:ID
Mailing Address - Zip Code:83276-1559
Mailing Address - Country:US
Mailing Address - Phone:208-547-3341
Mailing Address - Fax:208-547-2790
Practice Address - Street 1:300 S 3RD W
Practice Address - Street 2:
Practice Address - City:SODA SPRINGS
Practice Address - State:ID
Practice Address - Zip Code:83276-1559
Practice Address - Country:US
Practice Address - Phone:208-547-3341
Practice Address - Fax:208-547-2790
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARIBOU MEMORIAL HOSPITAL AND LIVING CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-03
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID37282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002863100Medicaid
ID002863500Medicaid
ID86934OtherBLUE CROSS PHYSICIAN
ID00042OtherBLUE CROSS OF IDAHO
ID002863200Medicaid
ID002863100Medicaid
ID1254707Medicare Oscar/Certification