Healthcare Provider Details

I. General information

NPI: 1205025673
Provider Name (Legal Business Name): BMH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 HOSPITAL WAY
POCATELLO ID
83201-5091
US

IV. Provider business mailing address

1151 HOSPITAL WAY
POCATELLO ID
83201-5091
US

V. Phone/Fax

Practice location:
  • Phone: 208-785-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

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