Provider Demographics
NPI:1679553531
Name:MINIDOKA MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:MINIDOKA MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-436-8141
Mailing Address - Street 1:1224 8TH ST
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-1527
Mailing Address - Country:US
Mailing Address - Phone:208-436-0481
Mailing Address - Fax:208-436-6038
Practice Address - Street 1:1224 8TH ST
Practice Address - Street 2:
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350-1527
Practice Address - Country:US
Practice Address - Phone:208-436-0481
Practice Address - Fax:208-434-8675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID26275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010006548OtherBLUE SHIELD
ID00166OtherBLUE CROSS
1254303OtherCIGNA GOVERNMENT SERVICES
IDM0023360Medicaid
ID000010006548OtherBLUE SHIELD
ID13Z319Medicare Oscar/Certification