Blackfoot Medical Clinic Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

P003 Issued in ID

Legal business name

BLACKFOOT MEDICAL CLINIC INC

Practice address

1441 Parkway Dr
Blackfoot, ID 83221-1667

Phone

(208) 785-2600

NPI assigned

Oct 9, 2007

Last updated

Feb 1, 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 Tibbits

Title

Administration

Phone

(208) 785-2600

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201824000000",
    "number": "1699963397",
    "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 INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-09",
        "last_updated": "2008-02-01",
        "status": "A",
        "authorized_official_last_name": "TIBBITS",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_title_or_position": "ADMINISTRATION",
        "authorized_official_telephone_number": "208-785-2600"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "ID",
            "license": "P003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Drew Bisharat, LPC
• Blackfoot Anesthesia Services LLC
• Blackfoot Behavioral Health, LLC
• Blackfoot Charter Community Learning Center
• Blackfoot Family Dentistry PLLC
• Blackfoot Medical Clinic Mental Health
• Blackfoot Medical Clinic RHC
• Blackfoot Medical Clinic Surgeons
• Blackfoot Medical Clinic, Inc
• Blackfoot Operations LLC (The Willows)

• Clinical Medical Laboratory in Blackfoot, ID
• Providers in Blackfoot, ID by specialty
• Clinical Medical Laboratory in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.