Organization
ST BENEDICTS FAMILY MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALAN STEVENSON (ADMINISTRATOR)
(208) 324-0425
Entity
Organization
Contact information
Practice address
414 N LINCOLN, SUITE 1, JEROME, ID 83338
(208) 324-0526
(208) 324-4809
Mailing address
709 N LINCOLN, JEROME, ID 83338
(208) 324-4301
(208) 324-3878
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
HH174
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010033877
BLUE SHIELD OF IDAHO
ID
05
—
00288500
—
ID
01
—
01701
BLUE CROSS OF IDAHO
ID
Enumeration date
10/02/2006
Last updated
08/22/2020
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