Shoshone Bannock Clinic

LBN: Shoshone Bannock Tribes, Inc
Shoshone Bannock Clinic is an health care organization with primary practice located at 717 Mission Road , Fort Hall ID 83203-0306. The organization recently has only one registered license in Ambulatory Health Care Facilities / Clinic/Center, which is considered as the primary health care specialty. Shoshone Bannock Tribes, Inc can be contacted via phone (208) 238-2400, or through Mendez, Angela via phone (208) 478-3744.

Contact Information

Primary practice address
717 Mission Road Fort Hall ID 83203-0306
Phone: (208) 238-2400
Fax: (208) 238-5462
Website:
Map and Directions
Authorized official contact:
Name: Mendez, Angela
Phone: (208) 478-3744

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Clinic/Center 261Q00000X

Profile Details

NPI number 1801949763
LBN Legal business name Shoshone Bannock Tribes, Inc
DBA Doing business as Shoshone Bannock Clinic
Authorized official Mendez, Angela
Entity Organization
Organization subpart 1 Yes
Enumeration date Jan 22nd, 2007
Last updated Jan 25th, 2010 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801949763 NPPES
Idaho MEDICAID 002264100
Idaho MEDICAID 003399100
Idaho MEDICAID 8063500
Idaho MEDICAID 8064977
Idaho MEDICAID 806648600
Idaho MEDICAID 80662922

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