| St. Mary's Hospital, Inc. | |
|
701 Lewiston St Cottonwood ID 83522-9750 | |
| (208) 962-3267 | |
| (208) 962-2313 |
| Full Name | St. Mary's Hospital, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 701 Lewiston St, Cottonwood, Idaho |
| Authorized Official Name and Position | Lenne Bonner (CEO) |
| Authorized Official Contact | 2084764555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Mary's Hospital, Inc. 2003 Kootenai Health Way Coeur D Alene ID 83814-6051 Ph: (208) 625-5085 | St. Mary's Hospital, Inc. 701 Lewiston St Cottonwood ID 83522-9750 Ph: (208) 962-3267 |
| NPI Number | 1174577100 |
|---|---|
| Provider Enumeration Date | 05/22/2006 |
| Last Update Date | 01/27/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174577100 | NPI | - | NPPES |
| 002283500 | Medicaid | ID | |
| 805066400 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Idaho) | Primary |
| 363L00000X | Nurse Practitioner | (Idaho) | Secondary |