IDAHO STREET MEDICAL CLINIC (NPI# 1023639622) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023639622 |
| Entity Type | Organization |
| Organization Name | IDAHO STREET MEDICAL CLINIC |
| Practice Address |
126 W. Idaho Ave Homedale ID 83628-8362 |
| Mailing Address |
24900 Market Rd Parma ID 83660-6723 |
| Practice Telephone | 2083377038 |
| Practice Fax Number | 2083374652 |
| Mailing Telephone | 2087227744 |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2020-05-05 |
| Authorized Official Name | EDITH MARY ROE (NURSE PRACTITIONER) |
| Authorized Official Telephone | 2088594103 |
| Authorized Official Credential | NP-BC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063970143 | Idaho Street Medical Clinic | Clinic/Center | 126 Idaho Ave., Homedale, ID 83628-8362 | 2019-03-07 |
| Street Address |
126 W. IDAHO AVE |
| City | HOMEDALE |
| State | ID |
| Zip Code | 83628-8362 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225390131 | Homedale Healthcare, Inc. | Skilled Nursing Facility | 108 E. Owyhee Avenue, Homedale, ID 83628 | 2012-06-15 |
| 1215219274 | Janet Woodburn | Pharmacist | 20 East Wyoming, Homedale, ID 83628 | 2011-09-15 |
| 1558545095 | Stacy Carol Fisher | Homeopath | 6 West Owyhee Avenue, Homedale, ID 83628 | 2007-12-19 |
| 1568661338 | Z-inc | Pharmacy | 20 E Wyoming, Homedale, ID 83628 | 2007-07-12 |
| 1245436427 | Community Health Clinics Inc | Clinic/Center | 116 E Idaho, Homedale, ID 83628 | 2007-06-25 |
| 1306984802 | A & A A Special Touch Home Care Inc | Home Health | 216 W Id Ave, Homedale, ID 83628 | 2007-02-05 |
| 1861573438 | Homedale Rural Fire Protection District | Ambulance | 36 West Colorado, Homedale, ID 83628 | 2006-10-18 |
| 1356430953 | Roe and Roe, Inc. | Pharmacy | 5 N. Main St., Homedale, ID 83628 | 2006-10-12 |
| 1083709034 | William Guy Jeppe Jr. | Dentist | 115 South Main, Homedale, ID 83628 | 2006-10-04 |
| 1861500456 | Owyhee Health and Rehabilitation Center | Skilled Nursing Facility | 108 W. Owyhee Ave., Homedale, ID 83628 | 2006-08-25 |
| Find all providers in zip 83628 | ||||
| Taxonomy Code | 261QH0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Definition to come... |
| Notes: [7/1/2006: modified title] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912516303 | Nova Integrative Health | Clinic/Center | 229 E Logan St, Caldwell, ID 83605-4835 | 2020-07-30 |
| 1508489600 | We Care Wellness Center, Inc. | Clinic/Center | 1484 E Bobwhite Ln, Post Falls, ID 83854-4949 | 2020-05-22 |
| 1316506413 | Sawtooth Family Medicine Pllc | Clinic/Center | 2320 E Gala St Ste 400, Meridian, ID 83642-4880 | 2019-06-12 |
| 1770059792 | New Plymouth Clinic | Clinic/Center | 213 N Plymouth Ave, New Plymouth, ID 83655-5532 | 2018-10-17 |
| 1477044543 | Place of Food | Clinic/Center | 1131 Cole St, Kimberly, ID 83341-5138 | 2018-05-24 |
| 1619351582 | Natural Family Health Inc. | Clinic/Center | 945 E River Spur, Priest River, ID 83856-5070 | 2015-07-10 |
| 1982026571 | Treasure Valley Family Health Care, LLC | Clinic/Center | 1055 N Echohawk Way, Eagle, ID 83616-5456 | 2014-01-16 |
| 1124303094 | N.e.x.t. Level Health Center, Inc. | Clinic/Center | 2105 Niagara, Idaho Falls, ID 83404 | 2011-10-11 |
| 1972821254 | Sohm Chiropractic Pa | Clinic/Center | 8382 W Ustick Rd, Suite 200, Boise, ID 83704-5986 | 2010-05-11 |
| 1588991566 | Ashton Memorial, Inc. | Clinic/Center | 23 S. 8th, Ashton, ID 83420 | 2009-11-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.