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SHOSHONE BANNOCK CLINIC
NPI 1801949763
Clinic/Center in Fort Hall, ID

Active since January 22, 2007
717 MISSION ROAD, FORT HALL, ID 83203(208) 238-2400(208) 238-5462 Get Directions Write a Review

NPPES record last updated: January 25, 2010. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Shoshone Bannock Clinic NPPES

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

SHOSHONE BANNOCK CLINIC (NPI 1801949763) is a healthcare organization registered as a clinic/center in Fort Hall, Idaho and active in the NPI registry since January 2007. The organization lists Angela Mendez, Tribal Health Director, as its authorized official.

NPPES Registry Identity

NPI1801949763
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameSHOSHONE BANNOCK TRIBES, INC
Location Address717 MISSION ROADFort Hall, ID 83203-0306
Mailing AddressPo Box 306Fort Hall, ID 83203-0306 · (208) 238-2400 · Fax (208) 238-5462
Phone(208) 238-2400
Fax(208) 238-5462
Organization SubpartYes
Authorized OfficialAngela MendezTribal Health Director · (208) 478-3744
Enumeration DateJanuary 22, 2007
Last NPPES UpdateJanuary 25, 2010
✔ NPI 1801949763 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ 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).
717 MISSION ROAD, Fort Hall, ID 83203
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Other Names 1

Doing Business AsShoshone Bannock Clinic

Other Identifiers 6

Medicaid002264100ID
Medicaid806648600ID
Medicaid003399100ID
Medicaid8064977ID
Medicaid8063500ID
Medicaid80662922ID

Other Providers at the Same Location NPPES 7

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

MISS CHANTELLE E BOWMAN PA-C
Physician Assistant
717 MISSION ROAD, COMMUNITY HEALTH NURSING PROGRAM
FORT HALL, ID 83203
Bingham County (208) 238-5435
MR. THAYNE ANDERSEN LCSW
Social Worker (Clinical)
717 MISSION ROAD
FORT HALL, ID 83203
Bingham County (208) 237-5631
DANIEL JEROME HALL LCSW
Social Worker (Clinical)
717 MISSION ROAD
FORT HALL, ID 83203
Bingham County (208) 237-5631
MRS. ASHLEY L BALLENSKY RN
Registered Nurse (Ambulatory Care)
717 MISSION ROAD
FORT HALL, ID 83203
Bingham County (208) 238-5423
NOT-TSOO GAH-NEE INDIAN HEALTH CENTER
Clinic/Center (Multi-Specialty)
717 MISSION ROAD
FORT HALL, ID 83203
Bingham County (208) 238-5400
SHOSHONE BANNOCK TRIBES
Podiatrist
717 MISSION ROAD
FORT HALL, ID 83203
Bingham County (208) 238-5421
MATTHEW J WADSWORTH LCSW
Social Worker (Clinical)
717 MISSION ROAD
FORT HALL, ID 83203
Bingham County (208) 237-5631

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 1801949763. It was assigned to this organization in the NPPES registry on January 22, 2007. The provider is doing business as Shoshone Bannock Clinic.

Where is Shoshone Bannock Tribes, Inc located?

Shoshone Bannock Tribes, Inc is located at 717 Mission Road, Fort Hall, ID 83203. The listed phone number is (208) 238-2400.

What is Shoshone Bannock Tribes, Inc's specialty?

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

When was this NPI record last updated?

The NPPES record for Shoshone Bannock Tribes, Inc was last updated on January 25, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.