Blackfoot Medical Clinic RHC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BLACKFOOT MEDICAL CLINIC RHC

Practice address

1441 Parkway Dr
Blackfoot, ID 83221-1667

Phone

(208) 785-2600

NPI assigned

Jul 29, 2008

Last updated

Jul 31, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sheila Tibbitts

Title

Administrator

Phone

(208) 785-2600

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Robert F Fallon MD3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Blackfoot Medical Clinic Mental Health

  • Professional Counselor
  • Blackfoot, ID
  • NPI 1265635205
  NPD tax ID
• Blackfoot Medical Clinic Surgeons

  • Surgery Physician
  • Blackfoot, ID
  • NPI 1740580794
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Christopher S Riley, MD

  • Surgery Physician
  • Blackfoot, ID
  • NPI 1831144757
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217462400000",
    "number": "1124283254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 PARKWAY DR",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832211667",
            "telephone_number": "208-785-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 PARKWAY DR",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832211667",
            "telephone_number": "208-785-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKFOOT MEDICAL CLINIC RHC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-29",
        "last_updated": "2008-07-31",
        "status": "A",
        "authorized_official_last_name": "TIBBITTS",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-785-2600"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002333900",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blackfoot Behavioral Health, LLC
• Blackfoot Charter Community Learning Center
• Blackfoot Family Dentistry PLLC
• Blackfoot Medical Clinic Inc
• Blackfoot Medical Clinic Mental Health
• Blackfoot Medical Clinic Surgeons
• Blackfoot Medical Clinic, Inc
• Blackfoot Operations LLC (The Willows)
• Blackfoot School Dist #55
• Blackfoot Smiles, P.a.

• Family Medicine Physician in Blackfoot, ID
• Providers in Blackfoot, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.