Organization Name: | MEMORIAL HOSPITAL - RADIOLOGY |
NPI Number: | 1639373772 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WADE JOHNSON (CEO) |
Mailing Address: | 645 E 5th St Weiser |
State: | ID US |
Postal Code: | 836722202 |
Phone Number: | 2085490370 |
Fax Number: | 2084144267 |
NPI Enumeration Date: | 06/13/2007 |
NPI Last Update Date: | 01/29/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 282NC0060X |
License Number: | 32 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Hospitals |
Taxonomy Classification: | General Acute Care Hospital |
Taxonomy Specialization: | Critical Access |
Taxonomy Definition: |