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Organization

BLACKFOOT MEDICAL CLINIC, INC

Active
Other names
SHELLEY FAMILY MEDICAL
Organization subpart
No

Provider details

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

Contact information

Practice address
210 S EMERSON ST, SHELLEY, ID 83274
(208) 357-7404
Mailing address
210 S EMERSON ST, SHELLEY, ID 83274

Taxonomy

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

Other

Enumeration date
09/22/2006
Last updated
08/15/2012
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