| NPI | 1376871749 |
|---|---|
| Other Name | BEAR LAKE MEMORIAL PART B |
| Entity Type | Organization |
| Authorized Contact | ROD JACOBSON CEO 208-847-1630 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Enumeration Date | 2009-11-24 |
| Last Update Date | 2011-01-19 |