# SOUTHEASTERN IDAHO MEDICAL CLINICS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Malad Valley Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982738662
- **Authorized official:** STEPHEN CHARLES JOHNSON D.O. (MEDICAL DIRECTOR)
- **Authorized official phone:** (208) 766-2267

## Contact information

- **Practice address:** 230 W 200 N, MALAD CITY, ID 83252-1109
- **Practice address phone:** (208) 766-2267
- **Practice address fax:** (208) 766-2342
- **Mailing address:** 2750 S 4100 W, MALAD CITY, ID 83252-6542
- **Mailing address phone:** (208) 766-4118
- **Mailing address fax:** (208) 766-2342

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 0-41 | ID | Yes |
| 261QR1300X | Rural Health Clinic/Center | 0-41 | ID | — |

## Other

- **Enumeration date:** 03/15/2007
- **Last updated:** 09/11/2025