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Organization
SOUTHEASTERN IDAHO MEDICAL CLINICS
Active
Organization
SOUTHEASTERN IDAHO MEDICAL CLINICS
Active
Other names
Malad Valley Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN CHARLES JOHNSON D.O. (MEDICAL DIRECTOR)
(208) 766-2267
Entity
Organization
Contact information
Practice address
230 W 200 N, MALAD CITY, ID 83252-1109
(208) 766-2267
(208) 766-2342
Mailing address
2750 S 4100 W, MALAD CITY, ID 83252-6542
(208) 766-4118
(208) 766-2342
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0-41
ID
261QR1300X
Rural Health Clinic/Center
0-41
ID
Other
Enumeration date
03/15/2007
Last updated
09/11/2025
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