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SHOSHONE-BANNOCK COMMUNITY HEALTH CENTER
NPI 1225414519
Clinic/Center in Fort Hall, ID

Active since August 10, 2015CLIA 13D2100443 · Microscopy
NAVAJO DRIVE BLDG 70, FORT HALL, ID 83203(208) 478-3995(208) 478-4040 Get Directions Write a Review

NPPES record last updated: January 19, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 19, 2022, Sep 20, 2017, Nov 10, 2016 (3 updates tracked since 2016).

About Shoshone-bannock Community Health Center NPPES

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

SHOSHONE-BANNOCK COMMUNITY HEALTH CENTER (NPI 1225414519) is a healthcare organization registered as a clinic/center in Fort Hall, Idaho and active in the NPI registry since August 2015. The organization holds a CLIA Microscopy certificate valid through June 18, 2027 and lists Melissa M Johnson, Credentialing Manager, as its authorized official.

NPPES Registry Identity

NPI1225414519
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameSHOSHONE BANNOCK TRIBES, INC
Location AddressNAVAJO DRIVE BLDG 70Fort Hall, ID 83203-0306
Mailing AddressPo Box 306Fort Hall, ID 83203-0306 · (208) 478-3995 · Fax (208) 478-4040
Phone(208) 478-3995
Fax(208) 478-4040
Organization SubpartNo
Authorized OfficialMelissa M JohnsonCredentialing Manager · (517) 896-3464
Enumeration DateAugust 10, 2015
Last NPPES UpdateJanuary 19, 20223 updates tracked since enumeration
NPPES CertifiedJanuary 19, 2022
✔ NPI 1225414519 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
Also ListedClinic/Center · Federally Qualified Health Center (FQHC)Taxonomy 261QF0400X
NAVAJO DRIVE BLDG 70, Fort Hall, ID 83203
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Other Names 1

Doing Business AsShoshone-bannock Community Health Center

Other Identifiers 1

Medicaid1225414519ID

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 13D2100443

Shoshone-Bannock Community Health Center · Fort Hall, ID
Active · expires Jun 18, 2027
CLIA Number13D2100443
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateJune 19, 2025
Certificate Expiration DateJune 18, 2027
Laboratory DirectorJesus Tellez-Hernandez
Laboratory Phone(208) 478-3987
Laboratory LocationShoshone-Bannock Community Health CenterBldg 70 Navajo Dr, Fort Hall, ID 83203
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHOSHONE-BANNOCK COMMUNITY HEALTH CENTER
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
NAVAJO DRIVE BLDG 70
FORT HALL, ID 83203
Bingham County (208) 478-3995

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 Shoshone Bannock Tribes, Inc's NPI number?

The NPI number for Shoshone Bannock Tribes, Inc is 1225414519. It was assigned to this organization in the NPPES registry on August 10, 2015. The provider is doing business as Shoshone-Bannock Community Health Center.

Where is Shoshone Bannock Tribes, Inc located?

Shoshone Bannock Tribes, Inc is located at Navajo Drive Bldg 70, Fort Hall, ID 83203. The listed phone number is (208) 478-3995.

What is Shoshone Bannock Tribes, Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Does Shoshone Bannock Tribes, Inc hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 13D2100443) is associated with this NPI, valid through June 18, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Shoshone Bannock Tribes, Inc was last updated on January 19, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.