CCN: 134010 NPI: 1992789101 Organization

STATE HOSPITAL SOUTH

700 EAST ALICE , BOX 400
BLACKFOOT, ID 83221

Contact Information

Phone 2087851200
Fax 2087858518
Enumeration Date 2005-12-01
Last Updated 2013-05-08

Taxonomies

Code: 283Q00000X (Primary) License State: ID License: #17

Inpatient Payment Attributes (IPSF) View Dictionary →

Effective Date:

censusDivision 8

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 1.068

censusDivision 8

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 1.358

censusDivision 8

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 1.358

censusDivision 8

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 1.336

censusDivision 8

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 1.336

censusDivision 8

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 1.152

censusDivision 8

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 1.152

censusDivision 8

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 1.067

censusDivision 8

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 1.067

censusDivision 8

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 1.046

censusDivision 8

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 1.046

censusDivision 8

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 1.013

censusDivision 8

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 1.013

censusDivision 8

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 1.007

censusDivision 8

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 1.007

censusDivision 8

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 1.007

censusDivision 8

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 0.937

censusDivision 8

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 0.937

Outpatient Payment Attributes (OPSF) View Dictionary →

Effective Date:

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 0.592

specialPaymentIndicator

costOfLivingAdjustment 0.001

carrierCode 02202

localityCode 00

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 0.592

specialPaymentIndicator

costOfLivingAdjustment 0.001

carrierCode 02202

localityCode 00

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 0.592

specialPaymentIndicator

costOfLivingAdjustment 0.001

carrierCode 02202

localityCode 00

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 0.592

specialPaymentIndicator

costOfLivingAdjustment 0.001

carrierCode 02202

localityCode 00

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 0.592

specialPaymentIndicator

costOfLivingAdjustment 0.001

carrierCode 02202

localityCode 00

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 0.592

specialPaymentIndicator

costOfLivingAdjustment 0.001

carrierCode 02202

localityCode 00

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 0.592

specialPaymentIndicator

costOfLivingAdjustment 0.001

carrierCode 02202

localityCode 00

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 0.592

specialPaymentIndicator

costOfLivingAdjustment 0.001

carrierCode 02202

localityCode 00

cbsaActualGeographicLocation 13

providerType 03

operatingCostToChargeRatio 0.592

specialPaymentIndicator 1

costOfLivingAdjustment 0.001

carrierCode 02202

localityCode 00

STATE HOSPITAL SOUTH

Contact Information

Taxonomies

Inpatient Payment Attributes (IPSF) View Dictionary →

Outpatient Payment Attributes (OPSF) View Dictionary →

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