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SHELLEY FAMILY MEDICAL
NPI 1366542391
Family Medicine in Shelley, ID

Active since September 22, 2006CLIA 13D0705400 · Waiver
210 S EMERSON ST, SHELLEY, ID 83274(208) 357-7404 Get Directions Write a Review

NPPES record last updated: August 15, 2012. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Shelley Family Medical NPPES

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

SHELLEY FAMILY MEDICAL (NPI 1366542391) is a healthcare organization registered as a family medicine in Shelley, Idaho and active in the NPI registry since September 2006. The organization holds a CLIA Waiver certificate valid through March 12, 2027 and lists Sheila Tibbitts, Administrator, as its authorized official.

NPPES Registry Identity

NPI1366542391
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameBLACKFOOT MEDICAL CLINIC, INC
Location Address210 S EMERSON STShelley, ID 83274
Mailing Address210 S Emerson StShelley, ID 83274
Phone(208) 357-7404
Organization SubpartNo
Authorized OfficialSheila TibbittsAdministrator · (208) 785-2600
Enumeration DateSeptember 22, 2006
Last NPPES UpdateAugust 15, 2012
✔ NPI 1366542391 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
210 S EMERSON ST, Shelley, ID 83274
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Other Names 1

Other NameShelley Family Medical

Other Identifiers 3

Medicare NSC0363970001ID
Medicare OSCAR/certification133839ID
Medicare PIN1374715ID

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

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 of Waiver 13D0705400

Shelley Family Medical Center · Shelley, ID
Active · expires Mar 12, 2027
CLIA Number13D0705400
Laboratory TypePhysician Office
Certificate Effective DateMarch 13, 2025
Certificate Expiration DateMarch 12, 2027
Laboratory DirectorKirt J. Mckinley
Laboratory Phone(208) 357-7404
Laboratory LocationShelley Family Medical Center210 S Emerson Ave, Shelley, ID 83274
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Blackfoot Medical Clinic, Inc's NPI number?

The NPI number for Blackfoot Medical Clinic, Inc is 1366542391. It was assigned to this organization in the NPPES registry on September 22, 2006. The provider is also known as Shelley Family Medical.

Where is Blackfoot Medical Clinic, Inc located?

Blackfoot Medical Clinic, Inc is located at 210 S Emerson St, Shelley, ID 83274. The listed phone number is (208) 357-7404.

What is Blackfoot Medical Clinic, Inc's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Blackfoot Medical Clinic, Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 13D0705400) is associated with this NPI, valid through March 12, 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 Blackfoot Medical Clinic, Inc was last updated on August 15, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.