Organization · Type 2 NPI

Shoshone Bannock Tribes, Inc

Clinic/Center · Fort Hall, ID

NPI number 1801949763 Active

Practice location

717 Mission Road
Fort Hall, ID 83203-0306

Call (208) 238-2400 Map

Fax (208) 238-5462

Mailing address

PO Box 306
Fort Hall, ID 83203-0306

Specialties and licenses

Taxonomy	Code	License
Clinic/Center Primary	261Q00000X	None listed

Clinic/Center: A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

6 other providers at this address

Other clinic/center providers in Fort Hall

Shoshone Bannock Tribes, IncClinic/Center Fort Hall, ID NPI 1225414519

See all in Fort Hall →

NPI record

NPI: 1801949763
Entity type: Organization (Type 2)
Issued: Jan 22, 2007
Last updated: Jan 25, 2010
Status: Active
Subpart: Yes of Shoshone Bannock Tribes, Inc

Other names

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Shoshone Bannock Clinic · doing business as

Authorized official

Ms. Angela Mendez
Tribal Health Director
(208) 478-3744

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1801949763

Shoshone Bannock Tribes, Inc's National Provider Identifier is 1801949763, issued on Jan 22, 2007. The primary taxonomy on file is Clinic/Center (261Q00000X), and the practice location is in Fort Hall, ID. The record was last updated on Jan 25, 2010.