Organization
BMH, INC.
Active
Other names
Blackfoot Orthopedic Center
Organization subpart
No
Provider details
NPI number
Authorized official
LISA RUDOLPH (PSO SUPPORT SPECIALIST)
(208) 782-3992
Entity
Organization
Contact information
Practice address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 785-2220
Mailing address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 785-2220
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002854200
—
ID
01
—
8L071
BLUE CROSS GRP OLD
ID
01
—
8N215
BLUE CROSS GRP
ID
Enumeration date
06/27/2007
Last updated
02/18/2009
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