Organization
COMMUNITY COUNCIL OF IDAHO, INC.
Active
Other names
Community Family Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ARNOLD CANTU (CLINIC ADMINISTRATOR)
(208) 528-7655
Entity
Organization
Contact information
Practice address
1491 PARKWAY DR, BLACKFOOT, ID 83221-1667
(208) 782-0500
(844) 328-7224
Mailing address
2100 ALAN ST, IDAHO FALLS, ID 83404-5801
(208) 528-7655
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
11/21/2006
Last updated
11/13/2023
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