| Idaho Dept Of Health & Welfare Reg 6 Cmh Bf C | |
|
701 E Alice Blackfoot ID 83221-0129 | |
| (208) 785-5826 | |
| (208) 785-1003 |
| Full Name | Idaho Dept Of Health & Welfare Reg 6 Cmh Bf C |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 701 E Alice, Blackfoot, Idaho |
| Authorized Official Name and Position | Ed Axford (PROGRAM MANAGER) |
| Authorized Official Contact | 2082347900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho Dept Of Health & Welfare Reg 6 Cmh Bf C Po Box 129 Blackfoot ID 83221-0129 Ph: (208) 785-5826 | Idaho Dept Of Health & Welfare Reg 6 Cmh Bf C 701 E Alice Blackfoot ID 83221-0129 Ph: (208) 785-5826 |
| NPI Number | 1710019476 |
|---|---|
| Provider Enumeration Date | 03/09/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710019476 | NPI | - | NPPES |
| 000010019402 | Other | ID | BLUE SHIELD |
| HW157 | Other | ID | BLUE CROSS |
| 8073650 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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› Verified 8 days ago
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