ELMORE MEDICAL CENTER SPECIALTY PHYSICIAN GROUP; NPI #1417122821

Contact Information

ELMORE MEDICAL CENTER SPECIALTY PHYSICIAN GROUP

890 N 6TH E
MOUNTAIN HOME, ID 83647-2206

Phone: 208-587-8401
Fax: 208-587-8406
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Critical Access	282NC0060X	A0[7]	Critical Access Hospital

Indicates primary specialty

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NPI Profile & details for ELMORE MEDICAL CENTER SPECIALTY PHYSICIAN GROUP

NPI # 1417122821

LBN Legal business name ELMORE MEDICAL CENTER SPECIALTY PHYSICIAN GROUP

Authorized official MARY JANOUSEK - (OFFICE MANAGER)

Entity Organization

Organization subpart ¹ Yes

Enumeration date 04/25/2008

Last updated 05/28/2009 - About 17 years ago

Identifiers

ID	Medicaid	002860700
ID	Other	8K594	BLUE CROSS
ID	Other	000014148578	BLUE SHIELD
ID	Other	000010149755	BLUE SHIELD PROF NUMBER

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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