TRI-STATE MEMORIAL HOSPITAL NPI 1386690907

NPI Information

NPI: 1386690907
Provider Name: TRI-STATE MEMORIAL HOSPITAL
Classification: Clinic/Center - 261QE0700X
Specialization: End-Stage Renal Disease (ESRD) Treatment
Entity Type: Organization
Former Legal Business Name: TRI STATE DIALYSIS CENTER
Address: 730 21ST ST
LEWISTON, ID
ZIP 83501
Phone: (208) 746-8280

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NPI Details

TRI-STATE MEMORIAL HOSPITAL is an end-stage renal disease (esrd) treatment clinic center in Lewiston, ID. TRI-STATE MEMORIAL HOSPITAL NPI is 1386690907. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Tri State Dialysis Center.

The provider's business location address is:

730 21ST ST
LEWISTON, ID
ZIP 83501-323
Phone: (208) 746-8280
Fax: (208) 746-8285

The provider's authorized official is Alex C. Town .
The authorized official title is Cfo and has the following contact phone number (509) 758-4667.

The enumeration date for this NPI number is 5/25/2006 and was last updated on 8/4/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment			No
2	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment	H-108	WASHINGTON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	502310	MEDICARE OSCAR/CERTIFICATION	WASHINGTON
2	132509	MEDICARE OSCAR/CERTIFICATION
3	003110900	MEDICAID	IDAHO
4	3308004	MEDICAID	WASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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