Caribou Memorial Hospital

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

37 Issued in ID

Legal business name

CARIBOU MEMORIAL HOSPITAL

Practice address

300 S 3Rd W
Soda Springs, ID 83276-1559

Phone

(208) 547-3341

Fax

(208) 547-2790

NPI assigned

Jun 6, 2007

Organization subpart

No

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

Authorized official

Name

John L Hoopes

Title

Ceo

Phone

(208) 547-3341

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• LAKEVIEW MEDICAL CLINIC Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Caribou County

  • Land Ambulance
  • Soda Springs, ID
  • NPI 1982696449

  Member Of

  NPD member

Locations

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Caribou Medical Center, Inc

  • Rural Health Clinic/Center
  • Soda Springs, ID
  • NPI 1548930878

  Sold to, 2021-08-01

  CMS change of ownership

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Caribou Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Soda Springs, ID
  • NPI 1598825028
  NPPES parent name
• Caribou Memorial Hospital

  • Skilled Nursing Facility
  • Soda Springs, ID
  • NPI 1750442240
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brent Christensen, DPM

  • Podiatrist
  • Pocatello, ID
  • NPI 1487688990
  NPD (past)
• Lee R Bules, D.O.

  • Family Medicine Physician
  • Delta, CO
  • NPI 1427015320
  NPD (past)

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356048000000",
    "number": "1154524403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 S 3RD W",
            "city": "SODA SPRINGS",
            "state": "ID",
            "postal_code": "832761559",
            "telephone_number": "208-547-3341",
            "fax_number": "208-547-2790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S 3RD W",
            "city": "SODA SPRINGS",
            "state": "ID",
            "postal_code": "832761559",
            "telephone_number": "208-547-3341",
            "fax_number": "208-547-2790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARIBOU MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2012-12-21",
        "status": "A",
        "authorized_official_last_name": "HOOPES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-547-3341"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "ID",
            "license": "37",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806721500",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8F975",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKEVIEW MEDICAL CLINIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Caribou Medical Center, Inc
• Caribou Medical Center, Inc
• Caribou Medical Center, Inc
• Caribou Medical Center, Inc.
• Caribou Medical Center, Inc.
• Caribou Memorial Hospital
• Caribou Memorial Hospital
• Caribou Memorial Hospital
• Preston Boyd Christensen, MD
• Terry Lee Christensen, LMT

• Rural Health Clinic/Center in Soda Springs, ID
• Providers in Soda Springs, ID by specialty
• Rural Health Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.