| State Hospital South Group | |
|
700 E Alice St Blackfoot ID 83221-4925 | |
| (208) 785-8506 | |
| (208) 785-8518 |
| Full Name | State Hospital South Group |
|---|---|
| Speciality | Psychologist |
| Location | 700 E Alice St, Blackfoot, Idaho |
| Authorized Official Name and Position | Lorna B Colvin (PATIENT ACCOUNT SPECIALIST) |
| Authorized Official Contact | 2087858506 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Hospital South Group 700 E Alice St Po Box 400 Blackfoot ID 83221-4925 Ph: (208) 785-8506 | State Hospital South Group 700 E Alice St Blackfoot ID 83221-4925 Ph: (208) 785-8506 |
| NPI Number | 1053615260 |
|---|---|
| Provider Enumeration Date | 01/03/2011 |
| Last Update Date | 01/03/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053615260 | NPI | - | NPPES |
| 00844 | Other | ID | BLUE CROSS |
| 1992789101 | Medicaid | ID | |
| 20315 | Other | ID | REGENCE BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 17 (Idaho) | Primary |
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A To Z Family Services Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 150 S Broadway St, Blackfoot, ID 83221 Phone: 208-785-1326 Fax: 208-785-1396 | |
Idaho Dept Of Health & Welfare Reg 7 Amh Bf Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 720 E Alice, Blackfoot, ID 83221 Phone: 208-785-5871 Fax: 208-785-5877 | |
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