Organization
BENEWAH MEDICAL CENTER
Active
Other names
Marimn Health
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL LEROY BERGLAND (CHIEF FINANCIAL OFFICER)
(208) 686-5162
Entity
Organization
Contact information
Practice address
427 N 12TH ST, PLUMMER, ID 83851
(208) 686-1931
Mailing address
PO BOX 388, PLUMMER, ID 83851-0388
(208) 686-1931
(208) 686-1146
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
131814
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0026771
—
ID
05
—
804166900
—
ID
05
—
805801300
—
ID
Enumeration date
09/27/2005
Last updated
03/29/2018
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