IDAHO STREET MEDICAL CLINIC; NPI #1063970143

Contact Information

IDAHO STREET MEDICAL CLINIC

126 IDAHO AVE.
HOMEDALE, ID 83628-8362

Phone: 208-859-4103
Fax:
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Rural Health	261QR1300X	B4[14]	Rural Health Clinic

Indicates primary specialty

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NPI Profile & details for IDAHO STREET MEDICAL CLINIC

NPI #	`1063970143`
LBN Legal business name	IDAHO STREET MEDICAL CLINIC
Authorized official	EDITH ROE - (PRESIDENT)
Entity	Organization
Organization subpart ¹	No
Enumeration date	03/07/2019
Last updated	03/07/2019 - About 7 years ago
Identifiers	n/a

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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