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IDAHO STREET MEDICAL CLINIC
NPI 1063970143
Clinic/Center - Rural Health in Homedale, ID

Active since March 07, 2019
126 IDAHO AVE., HOMEDALE, ID 83628(208) 859-4103 Get Directions Write a Review

NPPES record last updated: March 7, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Idaho Street Medical Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IDAHO STREET MEDICAL CLINIC (NPI 1063970143) is a healthcare organization registered as a rural health in Homedale, Idaho and active in the NPI registry since March 2019. The organization lists Edith Roe, President, as its authorized official.

NPPES Registry Identity

NPI1063970143
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NameIDAHO STREET MEDICAL CLINIC
Location Address126 IDAHO AVE.Homedale, ID 83628-8362
Mailing AddressPo Box 37Homedale, ID 83628-0037 · (208) 337-3898
Phone(208) 859-4103
Organization SubpartNo
Authorized OfficialEdith RoePresident · (208) 859-4103
Enumeration DateMarch 7, 2019
✔ NPI 1063970143 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities
Taxonomy Code261QR1300X
126 IDAHO AVE., Homedale, ID 83628
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Other Names 1

Doing Business AsIdaho Street Medical Clinic

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Idaho Street Medical Clinic's NPI number?

The NPI number for Idaho Street Medical Clinic is 1063970143. It was assigned to this organization in the NPPES registry on March 7, 2019.

Where is Idaho Street Medical Clinic located?

Idaho Street Medical Clinic is located at 126 Idaho Ave., Homedale, ID 83628. The listed phone number is (208) 859-4103.

What is Idaho Street Medical Clinic's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.

When was this NPI record last updated?

The NPPES record for Idaho Street Medical Clinic was last updated on March 7, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.