NPIMap

Family Health Services Corporation

Organization Active NPI Federally Qualified Health Center (FQHC) · Kimberly, ID

NPI 1154089795 · NPPES record last updated Dec 1, 2021

Key facts

NPI
1154089795
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
FAMILY HEALTH SERVICES CORPORATION
Practice address
214 1/2 South Oak
Kimberly, ID 83341
Phone
(208) 423-4170
NPI assigned
Dec 1, 2021
Organization subpart
No

Authorized official

Name
Stacey Blackwood
Title
Credentialing Specialist
Phone
(208) 737-6718

Other NPIs on the same Medicare enrollment 35

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 35

Medicare participation

Medicare fee-for-service enrollment
Enrolled in ID

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040216000531 ID Part B Supplier - Clinic/Group Practice 7012815038 Receives reassigned benefits from 77 practitioners
35 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kimberly, ID; Rupert, ID; Shoshone, ID; Twin Falls, ID; Bellevue, ID; Buhl, ID; Burley, ID; Declo, ID…

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor
Group: 193200000X MULTI-SPECIALTY GROUP		 101YM0800X
School Counselor
Group: 193200000X MULTI-SPECIALTY GROUP		 101YS0200X
Social Worker
Group: 193200000X MULTI-SPECIALTY GROUP		 104100000X
School Social Worker
Group: 193200000X MULTI-SPECIALTY GROUP		 1041S0200X
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

214 1/2 South Oak
Kimberly, ID 83341

Mailing address

794 Eastland Dr
Twin Falls, ID 83301-6856
Phone (208) 735-9363

Other names

  • Family Health Services Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 1, 2021.

{
    "created_epoch": "1638316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638316800000",
    "number": "1154089795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "794 EASTLAND DR",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016856",
            "telephone_number": "208-735-9363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 1/2 SOUTH OAK",
            "city": "KIMBERLY",
            "state": "ID",
            "postal_code": "83341",
            "telephone_number": "208-423-4170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH SERVICES CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-01",
        "last_updated": "2021-12-01",
        "certification_date": "2021-11-17",
        "status": "A",
        "authorized_official_last_name": "BLACKWOOD",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "208-737-6718"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, School",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, School",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Health Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kimberly, ID

All providers in Kimberly, ID · Federally Qualified Health Center (FQHC) in Idaho

Sources for this page

Verify at the official NPI Registry.