Provider Demographics
NPI:1730203845
Name:EASTERN IDAHO REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:EASTERN IDAHO REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HYPERBARIC MEDICINE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:GUYER
Authorized Official - Suffix:SR
Authorized Official - Credentials:M D
Authorized Official - Phone:208-529-7955
Mailing Address - Street 1:10701 S 1ST E
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7770
Mailing Address - Country:US
Mailing Address - Phone:208-529-9494
Mailing Address - Fax:
Practice Address - Street 1:10701 S 1ST E
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7770
Practice Address - Country:US
Practice Address - Phone:208-529-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDID000M3557282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDID000M3557OtherLICENSE #
IDID000M3557OtherLICENSE #
IDB63568Medicare UPIN