Healthcare Provider Details

I. General information

NPI: 1396608071
Provider Name (Legal Business Name): SNAKE RIVER COMMUNITY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 10TH ST
LEWISTON ID
83501-1910
US

IV. Provider business mailing address

215 10TH ST
LEWISTON ID
83501-1910
US

V. Phone/Fax

Practice location:
  • Phone: 208-743-5899
  • Fax: 208-743-9130
Mailing address:
  • Phone: 208-743-5899
  • Fax: 208-743-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEIDI BURFORD-BELL
Title or Position: CLINIC EXECUTIVE DIRECTOR
Credential:
Phone: 208-743-5899