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General NPI Number Information
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NPI Number | 1396608071
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Entity Type | Organization
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Legal Business Name | SNAKE RIVER COMMUNITY CLINIC
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 215 10TH ST
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City | LEWISTON
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State | ID
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Zip | 83501-1910
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Country | US
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Telephone | 208-743-5899
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Fax | 208-743-9130
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Provider Business Mailing Address
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Address Line | 215 10TH ST
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City | LEWISTON
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State | ID
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Zip | 83501-1910
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Country | US
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Telephone | 208-743-5899
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Fax | 208-743-9130
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Authorized Official
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Title or Position | CLINIC EXECUTIVE DIRECTOR
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Name | HEIDI BURFORD-BELL
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Credential |
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Telephone | 208-743-5899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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