Organization
SHOSHONE BANNOCK TRIBES
Active
Other names
SHOSHONE BANNOCK CLINIC PODIATRY GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANGELA MENDEZ (TRIBAL HEALTH DIRECTOR)
(208) 478-3994
Entity
Organization
Contact information
Practice address
717 MISSION ROAD, FORT HALL, ID 83203
(208) 238-5421
(208) 238-5462
Mailing address
PO BOX 306, PIMA DRIVE, FORT HALL, ID 83203-0306
(208) 478-3994
(208) 478-3943
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8066486
—
ID
Enumeration date
05/17/2007
Last updated
08/22/2020
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