| Idaho Street Medical Clinic | |
|
126 Idaho Ave. Homedale ID 83628-8362 | |
| (208) 859-4103 | |
| Not Available |
| Full Name | Idaho Street Medical Clinic |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 126 Idaho Ave., Homedale, Idaho |
| Authorized Official Name and Position | Edith Roe (PRESIDENT) |
| Authorized Official Contact | 2088594103 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho Street Medical Clinic Po Box 37 Homedale ID 83628-0037 Ph: (208) 337-3898 | Idaho Street Medical Clinic 126 Idaho Ave. Homedale ID 83628-8362 Ph: (208) 859-4103 |
| NPI Number | 1063970143 |
|---|---|
| Provider Enumeration Date | 03/07/2019 |
| Last Update Date | 03/07/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063970143 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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