Organization
SOUTHEASTERN IDAHO MEDICAL CLINICS
Active
Other names
Malad Valley Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN CHARLES JOHNSON D.O. (MEDICAL DIRECTOR)
(208) 766-2267
Entity
Organization
Contact information
Practice address
230 W 200 N, MALAD CITY, ID 83252-1109
(208) 766-2267
(208) 766-2342
Mailing address
2750 S 4100 W, MALAD CITY, ID 83252-6542
(208) 766-4118
(208) 766-2342
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0-41
ID
261QR1300X
Rural Health Clinic/Center
0-41
ID
Other
Enumeration date
03/15/2007
Last updated
09/11/2025
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