# BLACKFOOT MEDICAL CLINIC, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275633208
- **Authorized official:** SHEILA TIBBITTS (ADMINISTRATOR)
- **Authorized official phone:** (208) 785-2600

## Contact information

- **Practice address:** 114 S MAIN ST, FIRTH, ID 83236
- **Practice address phone:** (208) 346-6614
- **Mailing address:** 114 S MAIN ST, FIRTH, ID 83236

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/22/2006
- **Last updated:** 06/05/2008