NPIMap

Organization Active NPI

Minidoka Memorial Hospital Crna Group

  • Certified Registered Nurse Anesthetist
  • Rupert, ID
National Provider Identifier
1073787784
Registry record updated Oct 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
MINIDOKA MEMORIAL HOSPITAL CRNA GROUP
Practice address
1224 8TH St
Rupert, ID 83350-1527
Phone
(208) 436-0481
Fax
(208) 434-8675
NPI assigned
Apr 15, 2008
Last updated
Oct 3, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
MINIDOKA MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 3, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carl Hansen
Title
Administrator
Phone
(208) 436-0481

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X NU Primary

Addresses

Primary practice location

1224 8TH St
Rupert, ID 83350-1527

Mailing address

1224 8TH St
Rupert, ID 83350-1527
Phone (208) 436-0481

Other identifiers 3

IdentifierTypeStateIssuer
002336000OtherBLUE SHIELD
00166OtherBLUE CROSS OF IDAHO
M8068633MedicaidID

National Provider Directory

National Provider Directory
Tax ID family
Minidoka Memorial Hospi5 organizations share this tax ID, including this one
Part of
Minidoka Memorial Hospi

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317600000000",
    "number": "1073787784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1224 8TH ST",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833501527",
            "telephone_number": "208-436-0481",
            "fax_number": "208-434-8675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 8TH ST",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833501527",
            "telephone_number": "208-436-0481",
            "fax_number": "208-434-8675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINIDOKA MEMORIAL HOSPITAL CRNA GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MINIDOKA MEMORIAL HOSPITAL",
        "enumeration_date": "2008-04-15",
        "last_updated": "2011-10-03",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "CARL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-436-0481"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "002336000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "00166",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "M8068633",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rupert, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.