Shoshone Bannock Tribes

NPI #1952518946 in Fort Hall, Idaho

Provider Information

NPI Number: 1952518946
Entity Type: Organization
Organization Name: Shoshone Bannock Tribes
Primary Specialty: Podiatrist
Enumeration Date: May 17, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 717 MISSION ROAD
City: Fort Hall
State: Idaho
ZIP Code: 83203
Phone: (208) 238-5421

Authorized Official

Name: MS. ANGELA MENDEZ
Title: TRIBAL HEALTH DIRECTOR
Phone: (208) 478-3994

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Podiatrist	213E00000X	Primary

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