Organization · Type 2 NPI
Idaho Street Medical Clinic
Rural Health Clinic/Center · Homedale, ID
NPI number
1063970143
Active
Practice location
126 Idaho Ave.
Homedale, ID 83628-8362
Mailing address
PO Box 37
Homedale, ID 83628-0037
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Rural Health Clinic/Center Primary | 261QR1300X | None listed |
Rural Health Clinic/Center: Definition to come...
About NPI 1063970143
Idaho Street Medical Clinic's National Provider Identifier is 1063970143, issued on Mar 7, 2019. The primary taxonomy on file is Rural Health Clinic/Center (261QR1300X), and the practice location is in Homedale, ID. The record was last updated on Mar 7, 2019.