BOUNDARY COMMUNITY HOSPITAL (NPI# 1679621098) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679621098 |
| Entity Type | Organization |
| Organization Name | BOUNDARY COMMUNITY HOSPITAL |
| Practice Address |
6640 Kaniksu St Bonners Ferry ID 83805-7532 |
| Practice Telephone | 2082674850 |
| Mailing Telephone | 2082674850 |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2019-10-01 |
| Authorized Official Name | PRESTON J BECKER (CEO) |
| Authorized Official Telephone | 2082674850 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 43 | ID | Allopathic & Osteopathic Physicians |
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
43 | ID | Allopathic & Osteopathic Physicians |
| N | 207X00000X | Orthopaedic Surgery | 43 | ID | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
43 | ID | Allopathic & Osteopathic Physicians |
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
43 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 002810300 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801896683 | Boundary Community Hospital | General Acute Care Hospital | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 | 2005-07-22 |
| 1801273552 | Boundary Community Hospital | Clinic/Center | 6641 Kaniksu St, Bonners Ferry, ID 83805-7532 | 2015-05-01 |
| 1215082565 | Boundary Community Hospital | Pharmacy | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 | 2007-01-25 |
| 1316022247 | Boundary Community Hospital | Medicare Defined Swing Bed Unit | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 | 2006-10-26 |
| 1225113152 | Boundary Community Hospital | Skilled Nursing Facility | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 | 2006-10-26 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | BOUNDARY COMMUNITY HOSPITAL NURSING HOME | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 |
| Street Address |
6640 KANIKSU ST |
| City | BONNERS FERRY |
| State | ID |
| Zip Code | 83805-7532 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801896683 | Boundary Community Hospital | General Acute Care Hospital | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 | 2005-07-22 |
| 1912367251 | Jeffrey Petersen | Physical Therapist | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 | 2016-02-29 |
| 1124432943 | Mark Pruitt | Emergency Medicine | 6640 Kaniksu St, Bonners Ferry, ID 83805 | 2014-06-19 |
| 1942566195 | Edward Gregory Moellmer | Family Medicine | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 | 2012-04-02 |
| 1316250244 | Providence Health & Services - Boundary Community Hospital | Internal Medicine | 6640 Kaniksu St, Out Patient Dept. Lower Level, Bonners Ferry, ID 83805-7532 | 2010-07-20 |
| 1861609588 | Edna Faye Eby | Dietitian, Registered | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 | 2007-05-16 |
| 1215082565 | Boundary Community Hospital | Pharmacy | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 | 2007-01-25 |
| 1568517811 | Boundary Community Hospital Pharmacy | Pharmacy | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 | 2007-01-25 |
| 1679649396 | Stuart Kendall Willis IIi | Emergency Medicine | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 | 2006-11-27 |
| 1316022247 | Boundary Community Hospital | Medicare Defined Swing Bed Unit | 6640 Kaniksu St, Bonners Ferry, ID 83805-7532 | 2006-10-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366990996 | Nicole Diana Madill | Counselor | 687 Cody Street, Bonners Ferry, ID 83805 | 2016-09-12 |
| 1154770295 | Rachel Meiland Webster | Social Worker | 6686 Augusta Bldg 100, Bonners Ferry, ID 83805 | 2016-06-09 |
| 1205211786 | Robert Rossi | Social Worker | Kaniksu Health Services, 6615 Comanche St, Bonners Ferry, ID 83805 | 2015-07-24 |
| 1154660041 | Mark R. Barker, O.d.p.c. | Optometrist | 7177 Main St., Bonners Ferry, ID 83805 | 2013-02-12 |
| 1003182668 | Jessica Faye Horricks | Dentist | 6615 Commanche, Bonners Ferry, ID 83805 | 2012-03-28 |
| 1427334929 | Tanya Marie Allmaras | Physician Assistant | 6635 Comanche Street, Bonners Ferry, ID 83805 | 2011-10-27 |
| 1114259769 | Joshua Olen Shelton | Chiropractor | 6389 Bonner St., Bonners Ferry, ID 83805 | 2010-02-08 |
| 1558690644 | April C Christman | Social Worker | 6615 Comanche Street, Bonners Ferry, ID 83805 | 2009-12-18 |
| 1407006067 | Denys Taipale-knight | Counselor | 385 Moose Ridge Lane, Bonners Ferry, ID 83805 | 2008-09-19 |
| 1013126457 | John Pierce Brownlee Jr. | Registered Nurse | 6640 Kaniksu Street, Boundary Community Hospital, Bonners Ferry, ID 83805 | 2007-05-22 |
| Find all providers in zip 83805 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538516471 | Anthony Christopher Derrico | Emergency Medicine | 366 Gunfighter Ave Ste 498, Mountain Home Afb, ID 83648-5258 | 2016-05-20 |
| 1881752913 | Richard K Thurston | Emergency Medicine | 229 S 7th Street, St Maries, ID 83861 | 2006-12-04 |
| 1255399820 | Warren William Gude | Emergency Medicine | 600 Robbins Road, The Center for Wound Healing and Hyperbaric Medicine, Boise, ID 83702 | 2006-05-03 |
| 1821529918 | Jonathan Subaitani | Emergency Medicine | 11197 W Fairview Ave, Boise, ID 83713 | 2017-03-21 |
| 1841679669 | Robert John Hagenberg IIi | Emergency Medicine | 3080 E Gentry Way Ste 210, Meridian, ID 83642 | 2015-05-26 |
| 1194019406 | Michael Anderson | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2011-06-03 |
| 1508003104 | Rocky Mountain Emergency Physicians, LLC | Emergency Medicine | 777 Hospital Way, Pocatello, ID 83201 | 2009-01-19 |
| 1225201148 | Rodney Gillman Jay Jr. | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2008-04-11 |
| 1720114275 | North Idaho Immediate Care | Emergency Medicine | 750 N Syringa St, Suite 100, Post Falls, ID 83854-5275 | 2007-02-26 |
| 1407903669 | Debra K Mckinnon | Emergency Medicine | 700 S Main St, Moscow, ID 83843-3056 | 2007-01-03 |
| Find all providers with the same taxonomy | ||||
| City | BONNERS FERRY |
| Zip Code | 83805 |
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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.