| NPI | 1225414519 |
|---|---|
| Doing Business As | SHOSHONE-BANNOCK COMMUNITY HEALTH CENTER |
| Entity Type | Organization |
| Authorized Contact | MELISSA M JOHNSON Credentialing Manager 517-896-3464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2022-01-19 |