MINIDOKA MEMORIAL HOSPITAL (NPI# 1023052040) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023052040 |
| Entity Type | Organization |
| Organization Name | MINIDOKA MEMORIAL HOSPITAL |
| Other Organization Name | COUNTYSIDE CARE AND REHAB |
| Practice Address |
1224 8th St Rupert ID 83350-1527 |
| Practice Telephone | 2084360481 |
| Practice Fax Number | 2084366038 |
| Mailing Telephone | 2084360481 |
| Mailing Fax Number | 2084366038 |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2016-01-18 |
| Authorized Official Name | THOMAS J MURPHY (ADMINISTRATOR) |
| Authorized Official Telephone | 2084368141 |
| Is Organization Subpart | Y |
| Parent Organization Name | MINIDOKA MEMORIAL HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | H26 | ID | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | M0023369 | 05 |
| Other Name | Type Code |
|---|---|
| Countyside Care and Rehab | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043387426 | Minidoka Memorial Hospital | Clinic/Center | 1308 8th St, Suite 1, Rupert, ID 83350-1530 | 2006-11-29 |
| 1134333495 | Minidoka Memorial Hospital | Clinic/Center | 1224 8th St, Rupert, ID 83350-1527 | 2007-05-09 |
| 1942364070 | Minidoka Memorial Hospital | Pharmacy | 1224 8th St, Rupert, ID 83350-1527 | 2006-12-21 |
| 1205870219 | Minidoka Memorial Hospital | Home Health | 1224 8th St, Rupert, ID 83350-1527 | 2006-06-16 |
| 1679553531 | Minidoka Memorial Hospital | Medicare Defined Swing Bed Unit | 1224 8th St, Rupert, ID 83350-1527 | 2006-01-18 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MINIDOKA MEMORIAL HOSPITAL | 1224 8th St, Rupert, ID 83350-1527 |
| Street Address |
1224 8TH ST |
| City | RUPERT |
| State | ID |
| Zip Code | 83350-1527 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306836077 | Donald J Konrad | Family Medicine | 1224 8th St, Rupert, ID 83350-1527 | 2005-10-25 |
| 1215432984 | Rachel D Durrant | Speech-Language Pathologist | 1224 8th St, Rupert, ID 83350-1527 | 2018-03-26 |
| 1972763381 | Benjamin Guercio | Nurse Anesthetist, Certified Registered | 1224 8th St, Rupert, ID 83350-1527 | 2008-06-10 |
| 1073787784 | Minidoka Memorial Hospital Crna Group | Nurse Anesthetist, Certified Registered | 1224 8th St, Rupert, ID 83350-1527 | 2008-04-15 |
| 1225202922 | Minidoka Memorial Hospital Ambulance | Ambulance | 1224 8th St, Rupert, ID 83350-1527 | 2008-04-15 |
| 1134333495 | Minidoka Memorial Hospital | Clinic/Center | 1224 8th St, Rupert, ID 83350-1527 | 2007-05-09 |
| 1942364070 | Minidoka Memorial Hospital | Pharmacy | 1224 8th St, Rupert, ID 83350-1527 | 2006-12-21 |
| 1669578472 | Lori Johnson | Dietitian, Registered | 1224 8th St, Rupert, ID 83350-1527 | 2006-09-16 |
| 1205855202 | Jeffery D. Baldwin | Physical Therapist | 1224 8th St, Suite A, Rupert, ID 83350-1527 | 2006-07-19 |
| 1730104597 | Maria E. Hernandez | Physical Therapist | 1224 8th St, Suite A, Rupert, ID 83350-1527 | 2006-07-13 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417349515 | Robbie Joe Carroll | Registered Nurse | 1024 8th Street, Family Health Services, Rupert, ID 83350 | 2015-02-26 |
| 1285921643 | Duane Broderick | Counselor | 2311 Parke Ave., Ste. 8, Burley, ID 83350 | 2011-07-06 |
| 1598798282 | Kerry W Saurey | Family Medicine | 1218 9th St, Ste 7, Rupert, ID 83350 | 2006-07-08 |
| 1093761694 | Family Health Services Corporation | Dental Hygienist | 402 6th St, Rupert, ID 83350 | 2006-05-25 |
| 1376531004 | Jeffrey Scott Swenson | Family Medicine | 1308 8th St Ste 1, Rupert, ID 83350 | 2005-10-06 |
| 1205312774 | Shawna M Mccaffrey | Nurse Practitioner | 1308 8th St, Rupert, ID 83350 | 2018-07-17 |
| 1386872810 | Brian R Muir | Family Medicine | 1308 8th St Ste 1, Rupert, ID 83350 | 2009-06-23 |
| 1083816334 | Cameron Mchan | Nurse Practitioner | 1308 8th St Ste 1, Rupert, ID 83350 | 2007-05-31 |
| 1134225956 | Margo Saunders | Specialist | 1308 8th St Ste 1, Rupert, ID 83350 | 2006-09-16 |
| 1619900305 | Don C Pates | Family Medicine | 1218 9th St, Ste 7, Rupert, ID 83350 | 2006-07-08 |
| Find all providers in zip 83350 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
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|---|---|---|---|---|
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| 1497233514 | Boise Nursing and Rehab Center LLC | Skilled Nursing Facility | 1140 N Allumbaugh St, Boise, ID 83704-8716 | 2018-07-31 |
| 1295249241 | Boise of Cascadia, LLC | Skilled Nursing Facility | 6000 W. Denton St., Boise, ID 83706 | 2017-11-29 |
| 1356867683 | Nampa of Cascadia, LLC | Skilled Nursing Facility | 900 North Happy Valley Rd, Nampa, ID 83687 | 2017-08-18 |
| 1851836381 | Tanabell Health Services, Inc | Skilled Nursing Facility | 1134 Cheney Drive West, Twin Falls, ID 83301 | 2016-12-19 |
| 1871042663 | Ahc of Lewiston, LLC | Skilled Nursing Facility | 2852 Juniper Dr, Lewiston, ID 83501-4719 | 2016-09-22 |
| 1063966638 | Boise West of Cascadia, LLC | Skilled Nursing Facility | 8211 Ustick Road, Boise, ID 83704-5756 | 2016-08-11 |
| 1861946436 | Bellevue of Cascadia, LLC | Skilled Nursing Facility | 620 N. 6th Street, Bellevue, ID 83313 | 2016-08-11 |
| 1437603008 | Twin Falls of Cascadia, LLC | Skilled Nursing Facility | 674 Eastland Drive, Twin Falls, ID 83301-6846 | 2016-08-11 |
| 1235683806 | Payette of Cascadia, LLC | Skilled Nursing Facility | 1019 3rd Avenue South, Payette, ID 83661-2832 | 2016-08-11 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.