Organization
SOUTHERN IDAHO DIABETES EDUCATION PROGRAM
Active
Parent organization
SHOSHONE FAMILY MEDICAL CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
SHOSHONE FAMILY MEDICAL CENTER
Authorized official
KATHRYN EVALENA PIKE RN, CDE (SIDEP COORDINATOR)
(208) 944-4747
Entity
Organization
Contact information
Practice address
108 NW RAIL ST, SHOSHONE, ID 83352
(208) 944-4747
(208) 886-2634
Mailing address
113 S APPLE ST, SHOSHONE, ID 83352-5287
(208) 886-6222
(208) 886-2634
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
10/07/2008
Last updated
10/07/2008
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