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Contact Information

SOUTHEASTERN IDAHO MEDICAL CLINICS
230 W 200 N
MALAD CITY, ID83252-1109
 Phone: 208-766-2267
 Fax: 208-766-2342
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Rural Health

261QR1300X B4[14] Rural Health Clinic
Indicates primary specialty

NPI Profile & details for SOUTHEASTERN IDAHO MEDICAL CLINICS · (Female)

NPI # 1982738662
Status Active
Credentials
Entity Individual
Enumeration date 03/15/2007
Last updated 09/11/2025 - About 9 months ago
Sole proprietor 1 Not specified
Identifiers
  • ID License # 0-41
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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