Blackfoot Medical Clinic, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BLACKFOOT MEDICAL CLINIC, INC

Practice address

1441 Parkway Dr
Blackfoot, ID 83221-1667

Phone

(208) 785-2600

Fax

(208) 785-8185

NPI assigned

Jul 5, 2006

Last updated

Jul 19, 2012By 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

Betty Miller

Title

Business Office Manager

Phone

(208) 785-2600

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• MVH BMC LLC

  dba Blackfoot Medical Center

  • Rural Health Clinic/Center
  • Blackfoot, ID
  • NPI 1467816579

  Sold to, 2016-05-01

  CMS change of ownership

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.

• Jonathan Keith Williams, NP

  • Family Nurse Practitioner
  • Idaho Falls, ID
  • NPI 1821253683
  NPD (past)

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342656000000",
    "number": "1235160441",
    "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",
            "fax_number": "208-785-8185"
        },
        {
            "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",
            "fax_number": "208-785-8185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKFOOT MEDICAL CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2012-07-19",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "BETTY",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "208-785-2600"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blackfoot Family Dentistry PLLC
• Blackfoot Medical Clinic Inc
• Blackfoot Medical Clinic Mental Health
• Blackfoot Medical Clinic RHC
• Blackfoot Medical Clinic Surgeons
• Blackfoot Operations LLC (The Willows)
• Blackfoot School Dist #55
• Blackfoot Smiles, P.a.
• Blackfoot Vision Care Associates
• Bluebird Family Eye Care PLLC

• 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 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.