Healthcare Provider Details

I. General information

NPI: 1992172993
Provider Name (Legal Business Name): BMH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 POPLAR ST
BLACKFOOT ID
83221-1741
US

IV. Provider business mailing address

98 POPLAR ST
BLACKFOOT ID
83221-1758
US

V. Phone/Fax

Practice location:
  • Phone: 208-782-2444
  • Fax: 208-785-3115
Mailing address:
  • Phone: 208-785-4100
  • Fax: 208-785-8529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: JACOB ERICKSON
Title or Position: CEO
Credential:
Phone: 208-785-3801