Shoshone Bannock Tribes, INC

NPI #1801949763 in Fort Hall, Idaho

Provider Information

NPI Number: 1801949763
Entity Type: Organization
Organization Name: Shoshone Bannock Tribes, INC
Subpart: Yes (part of a larger organization)
Parent Organization: SHOSHONE BANNOCK TRIBES, INC
Primary Specialty: Clinic/Center
Enumeration Date: Jan 22, 2007
Last Updated: Jan 25, 2010

Practice Location

Address: 717 MISSION ROAD
City: Fort Hall
State: Idaho
ZIP Code: 83203-0306
Phone: (208) 238-2400

Authorized Official

Name: MS. ANGELA MENDEZ
Title: TRIBAL HEALTH DIRECTOR
Phone: (208) 478-3744

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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