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777 Hospital Way Pocatello ID 83201-5175 | |
| (208) 239-1000 | |
| (208) 239-2134 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 777 Hospital Way, Pocatello, Idaho |
| Authorized Official Name and Position | Stephen C. Petrovich (EVP GENERAL COUNSEL) |
| Authorized Official Contact | 6152963594 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
777 Hospital Way Pocatello ID 83201-5175 Ph: (208) 239-1000 | 777 Hospital Way Pocatello ID 83201-5175 Ph: (208) 239-1000 |
| NPI Number | 1295777274 |
|---|---|
| Provider Enumeration Date | 06/12/2006 |
| Last Update Date | 04/19/2022 |
| Certification Date | 04/19/2022 |
| Medicare PECOS PAC ID | 8527115534 |
|---|---|
| Medicare Enrollment ID | O20091216000599 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295777274 | NPI | - | NPPES |
| 806570500 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | H12 (Idaho) | Primary |
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