POCATELLO HOSPITAL LLC (NPI# 1790751055) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790751055 |
| Entity Type | Organization |
| Organization Name | POCATELLO HOSPITAL LLC |
| Other Organization Name | PORTNEUF MEDICAL CENTER |
| Practice Address |
777 Hospital Way Pocatello ID 83201-5175 |
| Practice Telephone | 2082391000 |
| Practice Fax Number | 2082391934 |
| Mailing Telephone | 2082391000 |
| Mailing Fax Number | 2082391934 |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2014-05-02 |
| Authorized Official Name | MR. JOHN ABREU (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 2082391020 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282N00000X | General Acute Care Hospital | 12 | ID | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | MEDICARE OSCAR | 130028 | 01 |
| Other Name | Type Code |
|---|---|
| Portneuf Medical Center | Doing Business As Name - Organization |
| Street Address |
777 HOSPITAL WAY |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201-5175 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104825892 | Gregory S Harrison | Neurological Surgery | 777 Hospital Way, Suite 115, Pocatello, ID 83201-5175 | 2005-07-15 |
| 1801401344 | Sunny Blue Alene Nelson | Physician Assistant | 777 Hospital Way, Pocatello, ID 83201-5175 | 2020-09-11 |
| 1316570757 | Mark Alan Pendleton | Nurse Anesthetist, Certified Registered | 777 Hospital Way, Pocatello, ID 83201-5175 | 2020-02-13 |
| 1508413220 | Hilary Worthen | Specialist/Technologist | 777 Hospital Way, Pocatello, ID 83201-5175 | 2019-08-19 |
| 1437612447 | Walter S Medlin Md PC | Surgery | 777 Hospital Way, Pocatello, ID 83201-5175 | 2019-04-08 |
| 1396203428 | Amber Frost | Family Medicine | 777 Hospital Way, Pocatello, ID 83201-5175 | 2019-03-07 |
| 1649756404 | Kamilla Gundersen | Nurse Practitioner | 777 Hospital Way, Pocatello, ID 83207 | 2018-07-16 |
| 1043716285 | Brice Anderson | Specialist/Technologist | 777 Hospital Way, Pocatello, ID 83201-5175 | 2018-04-05 |
| 1851808133 | Rocky Mountain Physician Group LLC | Emergency Medicine | 777 Hospital Way, Pocatello, ID 83201-5175 | 2018-01-08 |
| 1154838886 | Mark Willis | Nurse Practitioner | 777 Hospital Way, Pocatello, ID 83201-5175 | 2018-01-03 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
| 1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
| 1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
| 1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
| 1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
| 1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
| Find all providers in zip 83201 | ||||
| Taxonomy Code | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689802852 | Pocatello Health Services, LLC | General Acute Care Hospital | 651 Memorial Dr, Pocatello, ID 83201-4071 | 2009-06-26 |
| 1215165485 | Pocatello Health Services, LLC | General Acute Care Hospital | 777 Hospital Way, Pocatello, ID 83201-5175 | 2009-06-26 |
| 1760610935 | Pocatello Hospital, LLC | General Acute Care Hospital | 651 Memorial Dr, Pocatello, ID 83201-4071 | 2009-06-26 |
| 1083852727 | Pocatello Health Services, LLC | General Acute Care Hospital | 651 Memorial Dr, Pocatello, ID 83201-4071 | 2009-02-03 |
| 1205005832 | Portneuf Medical Center | General Acute Care Hospital | 651 Memorial Dr, Pocatello, ID 83201-4071 | 2008-02-28 |
| 1679742209 | Portneuf Medical Center | General Acute Care Hospital | 651 Memorial Dr, Pocatello, ID 83201-4071 | 2008-02-28 |
| 1538351796 | Portneuf Medical Center | General Acute Care Hospital | 651 Memorial Dr, Pocatello, ID 83201-4071 | 2007-08-13 |
| 1750323515 | Portneuf Medical Center | General Acute Care Hospital | 651 Memorial Dr, Pocatello, ID 83201-4071 | 2006-06-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508386707 | Emp Idaho Nampa, LLC | General Acute Care Hospital | 350 E Myrtle Street, Suite 100, Boise, ID 83702 | 2017-06-20 |
| 1225379183 | Sterling Hospital LLC | General Acute Care Hospital | 5412 S. Rock House Cir, Idaho Falls, ID 83406 | 2013-03-01 |
| 1023367828 | Stanley J Waters | General Acute Care Hospital | 1795 S Sub Station Rd, Emmett, ID 83617-9431 | 2012-09-07 |
| 1194908053 | Boise Intensive Care Hospital, Inc. | General Acute Care Hospital | 2131 South Bonito Way, Meridian, ID 83642-1659 | 2007-12-13 |
| 1346454337 | West Valley Medical Center | General Acute Care Hospital | 3720 S Indiana Ave, Caldwell, ID 83605 | 2007-05-09 |
| 1730203845 | Eastern Idaho Regional Medical Center | General Acute Care Hospital | 10701 S 1st E, Idaho Falls, ID 83404-7770 | 2007-03-16 |
| 1942308986 | Idaho Falls Recovery Center | General Acute Care Hospital | 1957 E 17th Street, Idaho Falls, ID 83404 | 2006-09-21 |
| 1609818483 | West Valley Medical Center Inc | General Acute Care Hospital | 381 B South Middleton Road, Middleton, ID 83644 | 2006-06-13 |
| 1992747570 | Madison Co Memorial Hospital | General Acute Care Hospital | 450 E. Main, Rexburg, ID 83440 | 2006-06-11 |
| 1144287756 | Bonner General Hospital, Inc. | General Acute Care Hospital | 520 N 3rd Ave, Sandpoint, ID 83864-1507 | 2006-04-27 |
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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.