Organization
IDAHO STREET MEDICAL CLINIC
Active
Organization
IDAHO STREET MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDITH MARY ROE NP-BC (NURSE PRACTITIONER)
(208) 859-4103
Entity
Organization
Contact information
Practice address
126 W. IDAHO AVE, HOMEDALE, ID 83628-8362
(208) 337-7038
(208) 337-4652
Mailing address
24900 MARKET RD, PARMA, ID 83660-6723
(208) 722-7744
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
05/05/2020
Last updated
05/05/2020
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up