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STATE HOSPITAL SOUTH MEDICAL CLINIC
NPI 1538225545
Clinic/Center in Blackfoot, ID

Active since December 28, 2006CLIA 13D0520437 · Waiver
700 E. ALICE, BOX 400, BLACKFOOT, ID 83221(208) 785-1200(208) 785-8518 Get Directions Write a Review

NPPES record last updated: July 15, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 15, 2016, May 12, 2016 (2 updates tracked since 2016).

About State Hospital South Medical Clinic NPPES

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

STATE HOSPITAL SOUTH MEDICAL CLINIC (NPI 1538225545) is a healthcare organization registered as a clinic/center in Blackfoot, Idaho and active in the NPI registry since December 2006. The organization holds a CLIA Waiver certificate valid through October 21, 2026 and lists Lynn D Shields, Patient Accounts Specialist, as its authorized official.

NPPES Registry Identity

NPI1538225545
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameSTATE OF IDAHO DEPARTMENT OF HEALTH AND WELFARE
Location Address700 E. ALICE, BOX 400Blackfoot, ID 83221-0400
Mailing Address700 E. Alice, Po Box 400Blackfoot, ID 83221-0400 · (208) 785-1200 · Fax (208) 785-8518
Phone(208) 785-1200
Fax(208) 785-8518
Organization SubpartYesParent: State Hospital South
Authorized OfficialLynn D ShieldsPatient Accounts Specialist · (208) 785-8462
Enumeration DateDecember 28, 2006
Last NPPES UpdateJuly 15, 20162 updates tracked since enumeration
✔ NPI 1538225545 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
License✔ Licensed in ID · 17
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).
700 E. ALICE, Blackfoot, ID 83221
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Other Names 1

Doing Business AsState Hospital South Medical Clinic

Other Identifiers 5

Medicaid002823200ID
Medicare OSCAR/certification1373057ID
Medicare PIN20002136
Medicare UPING87318ID
Medicare PIN20002136ID

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 13D0520437

State Hospital South · Blackfoot, ID
Active · expires Oct 21, 2026
CLIA Number13D0520437
Laboratory TypeOther
Certificate Effective DateOctober 22, 2024
Certificate Expiration DateOctober 21, 2026
Laboratory DirectorMark Lupton
Laboratory Phone(208) 785-1200
Laboratory LocationState Hospital South700 E Alice St, Blackfoot, ID 83221
CLIA data matches this NPI record on: Address 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 State Of Idaho Department Of Health And Welfare's NPI number?

The NPI number for State Of Idaho Department Of Health And Welfare is 1538225545. It was assigned to this organization in the NPPES registry on December 28, 2006. The provider is doing business as State Hospital South Medical Clinic.

Where is State Of Idaho Department Of Health And Welfare located?

State Of Idaho Department Of Health And Welfare is located at 700 E. Alice Box 400, Blackfoot, ID 83221. The listed phone number is (208) 785-1200.

What is State Of Idaho Department Of Health And Welfare's specialty?

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

Does State Of Idaho Department Of Health And Welfare hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 13D0520437) is associated with this NPI, valid through October 21, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for State Of Idaho Department Of Health And Welfare was last updated on July 15, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.