Healthcare Provider Details

I. General information

NPI: 1366630949
Provider Name (Legal Business Name): BMH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W LOCUST ST
SHELLEY ID
83274-1230
US

IV. Provider business mailing address

275 W LOCUST ST
SHELLEY ID
83274-1230
US

V. Phone/Fax

Practice location:
  • Phone: 208-782-2960
  • Fax:
Mailing address:
  • Phone: 208-782-2960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number36
License Number StateID

VIII. Authorized Official

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