| NPI | 1063970143 |
|---|---|
| Doing Business As | IDAHO STREET MEDICAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | EDITH ROE President 208-859-4103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2019-03-07 |