IDAHO STREET MEDICAL CLINIC
NPI 1023639622
Clinic/Center - Health Service in Homedale, ID
NPI Status: Active since May 05, 2020
Contact Information
126 W. IDAHO AVE
HOMEDALE, ID
ZIP 83628
Phone: (208) 337-7038
Fax: (208) 337-4652
- Organization
- Clinic/Center
- Health Service
- CLIA Number: 13D2165553
- CLIA Cert. Type: Community Clinic
- CLIA Exp. Date: 04-29-2027
About IDAHO STREET MEDICAL CLINIC
This page provides the complete NPI Profile along with additional information for Idaho Street Medical Clinic, a provider established in Homedale, Idaho operating as a Clinic/center, focusing in health service . The healthcare provider is registered in the NPI registry with number 1023639622 assigned on May 2020. The practitioner's primary taxonomy code is 261QH0100X. The provider is registered as an organization and their NPI record was last updated 6 years ago. The authorized official of this NPI record is Edith Mary Roe Np-bc (Nurse Practitioner)
- NPI
- 1023639622
- Provider Name
- IDAHO STREET MEDICAL CLINIC
- Entity Type
- Organization
- Location Address
- 126 W. IDAHO AVE HOMEDALE, ID 83628
- Location Phone
- (208) 337-7038
- Location Fax
- (208) 337-4652
- Mailing Address
- 24900 MARKET RD PARMA, ID 83660
- Mailing Phone
- (208) 722-7744
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 05-05-2020
- Last Update Date
- 05-05-2020
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Health Service
- Taxonomy Code
- 261QH0100X
- Type
- Ambulatory Health Care Facilities
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 13D2165553
- Facility Type
- Community Clinic
- Certificate Effective Date
- April 30, 2025
- Certificate Expiration Date
- April 29, 2027
- Laboratory Director
- EDITH M. ROE CNP
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Idaho Street Medical Clinic to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
Reviews for IDAHO STREET MEDICAL CLINIC
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1023639622, we treat the final digit (2) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 58. The final step is to find the difference between that total and the next multiple of ten (60 - 58 = 2).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 58 is 60. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1023639622, enumerated as an "organization" on May 05, 2020.
The provider is located at 126 W. IDAHO AVE HOMEDALE, ID 83628 and the phone number is (208) 337-7038.
Clinic/Center with taxonomy code 261QH0100X and a focus in Health Service.
