NPIMap

Organization Active NPI

Pocatello Hospital LLC

  • Internal Medicine Physician
  • Pocatello, ID
National Provider Identifier
1760610935
Registry record updated Apr 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
POCATELLO HOSPITAL LLC
Practice address
651 Memorial Dr
Pocatello, ID 83201-4071
Phone
(208) 239-2110
Fax
(208) 239-2145
NPI assigned
Jun 26, 2009
Last updated
Apr 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2022

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

Authorized official

Name
Stephen C. Petrovich
Title
Evp, General Counsel
Phone
(615) 296-3594

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
General Acute Care Hospital 282N00000X 12 ID
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X

Addresses

Primary practice location

651 Memorial Dr
Pocatello, ID 83201-4071

Mailing address

651 Memorial Dr
Pocatello, ID 83201-4071
Phone (208) 239-2110

National Provider Directory

National Provider Directory

Member of 1

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

Locations

777 Hospital Way
#115
Pocatello, ID 83201
Phone (208) 239-1000

777 Hospital Way
#202
Pocatello, ID 83201

777 Hospital Way
#G11
Pocatello, ID 83201
Phone (208) 239-1710

777 Hospital Way
Ste 101
Pocatello, ID 83201
Phone (208) 234-2001

777 Hospital Way
Ste 115
Pocatello, ID 83201
Phone (208) 239-1960

777 Hospital Way
Ste 215
Pocatello, ID 83201
Phone (208) 239-2580

777 Hospital Way
Ste 301
Pocatello, ID 83201

Practitioners & affiliated clinicians

Practitioners 177

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 177

NPI Registry JSON

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

{
    "created_epoch": "1245974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650326400000",
    "number": "1760610935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "651 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014071",
            "telephone_number": "208-239-2110",
            "fax_number": "208-239-2145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014071",
            "telephone_number": "208-239-2110",
            "fax_number": "208-239-2145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POCATELLO HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-26",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A",
        "authorized_official_last_name": "PETROVICH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "EVP, GENERAL COUNSEL",
        "authorized_official_telephone_number": "615-296-3594"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "ID",
            "license": "12",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2022; 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.