Organization
BLACKFOOT MEDICAL CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHEILA TIBBITTS (ADMINISTRATOR)
(208) 785-2600
Entity
Organization
Contact information
Practice address
114 S MAIN ST, FIRTH, ID 83236
(208) 346-6614
Mailing address
114 S MAIN ST, FIRTH, ID 83236
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806884200
—
ID
Enumeration date
09/22/2006
Last updated
06/05/2008
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