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Organization
BLACKFOOT MEDICAL CLINIC, INC
Active
Organization
BLACKFOOT MEDICAL CLINIC, INC
Active
Other names
SHELLEY FAMILY MEDICAL
Organization subpart
No
Provider details
NPI number
Authorized official
SHEILA TIBBITTS (ADMINISTRATOR)
(208) 785-2600
Entity
Organization
Contact information
Practice address
210 S EMERSON ST, SHELLEY, ID 83274
(208) 357-7404
Mailing address
210 S EMERSON ST, SHELLEY, ID 83274
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
09/22/2006
Last updated
08/15/2012
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