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Organization

BLACKFOOT MEDICAL CLINIC RHC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SHEILA TIBBITTS (ADMINISTRATOR)
(208) 785-2600
Entity
Organization

Contact information

Practice address
1441 PARKWAY DR, BLACKFOOT, ID 83221-1667
(208) 785-2600
Mailing address
1441 PARKWAY DR, BLACKFOOT, ID 83221-1667
(208) 785-2600

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
002333900
ID
Enumeration date
07/29/2008
Last updated
07/31/2008
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