Idaho Street Medical Clinic

LBN: Idaho Street Medical Clinic
Idaho Street Medical Clinic is an health care organization with primary practice located at 126 W. Idaho Ave , Homedale ID 83628-8362. The organization recently has only one registered license in Ambulatory Health Care Facilities / Health Service, which is considered as the primary health care specialty. Idaho Street Medical Clinic can be contacted via phone (208) 337-7038, or through Roe, Edith Mary via phone (208) 859-4103.

Contact Information

Primary practice address
126 W. Idaho Ave Homedale ID 83628-8362
Phone: (208) 337-7038
Fax: (208) 337-4652
Website:
Map and Directions
Authorized official contact:
Name: Roe, Edith Mary NP-BC
Phone: (208) 859-4103

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Health Service 261QH0100X

Profile Details

NPI number 1023639622
LBN Legal business name Idaho Street Medical Clinic
DBA Doing business as
Authorized official Roe, Edith Mary NP-BC
Entity Organization
Organization subpart 1 No
Enumeration date May 5th, 2020
Last updated May 5th, 2020 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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