Healthcare Provider Details

I. General information

NPI: 1669615845
Provider Name (Legal Business Name): BMH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 POPLAR ST MOB BUILDING
BLACKFOOT ID
83221-1758
US

IV. Provider business mailing address

98 POPLAR ST MOB BUILDING
BLACKFOOT ID
83221-1758
US

V. Phone/Fax

Practice location:
  • Phone: 208-782-2990
  • Fax: 208-792-2931
Mailing address:
  • Phone: 208-782-2990
  • Fax: 208-792-2931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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