Healthcare Provider Details

I. General information

NPI: 1215398672
Provider Name (Legal Business Name): BMH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 E 17TH ST
IDAHO FALLS ID
83404-6365
US

IV. Provider business mailing address

98 POPLAR ST
BLACKFOOT ID
83221-1758
US

V. Phone/Fax

Practice location:
  • Phone: 208-535-3615
  • Fax: 208-523-5343
Mailing address:
  • Phone: 208-782-3969
  • Fax: 208-782-2984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateID

VIII. Authorized Official

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