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General NPI Number Information
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NPI Number | 1073188728
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Entity Type | Organization
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Legal Business Name | FAMILY HEALTH SERVICES CORPORATION
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 114 PIONEER CT
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City | JEROME
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State | ID
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Zip | 83338-5193
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Country | US
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Telephone | 208-732-7125
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Fax | 208-933-4417
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Provider Business Mailing Address
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Address Line | 794 EASTLAND DR
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City | TWIN FALLS
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State | ID
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Zip | 83301-6856
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Country | US
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Telephone | 208-737-6718
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Fax | 208-734-5036
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | STACEY BLACKWOOD
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Credential |
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Telephone | 208-737-6718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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