Shoshone Bannock Tribes, INC
NPI #1225414519 in Fort Hall, Idaho
Provider Information
- NPI Number
- 1225414519
- Entity Type
- Organization
- Organization Name
- Shoshone Bannock Tribes, INC
- Primary Specialty
- Clinic/Center
- Enumeration Date
- Aug 10, 2015
- Last Updated
- Jan 19, 2022
Practice Location
Authorized Official
- Name
- MELISSA M JOHNSON
- Title
- CREDENTIALING MANAGER
- Phone
- (517) 896-3464
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Federally Qualified Health Center (FQHC) — Federally Qualified Health Center (FQHC) |
| Clinic/Center |
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