Organization · Type 2 NPI
Idaho Street Medical Clinic
Health Service Clinic/Center · Homedale, ID
NPI number
1023639622
Active
Practice location
126 W. Idaho Ave
Homedale, ID 83628-8362
Fax (208) 337-4652
Mailing address
24900 Market Rd
Parma, ID 83660-6723
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Health Service Clinic/Center Primary | 261QH0100X | None listed |
Health Service Clinic/Center: Definition to come...
About NPI 1023639622
Idaho Street Medical Clinic's National Provider Identifier is 1023639622, issued on May 5, 2020. The primary taxonomy on file is Health Service Clinic/Center (261QH0100X), and the practice location is in Homedale, ID. The record was last updated on May 5, 2020.