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General NPI Number Information
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NPI Number | 1922037530
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Entity Type | Organization
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Legal Business Name | ST BENEDICTS FAMILY MEDICAL CENTER
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 115 5TH AVE W
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City | JEROME
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State | ID
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Zip | 83338-1824
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Country | US
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Telephone | 208-324-8831
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Fax | 208-324-6678
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Provider Business Mailing Address
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Address Line | 115 5TH AVE W
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City | JEROME
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State | ID
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Zip | 83338-1824
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Country | US
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Telephone | 208-324-8831
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Fax | 208-324-6678
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Authorized Official
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Title or Position | CEO
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Name | MR. WARREN ALAN STEVENSON
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Credential |
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Telephone | 208-324-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | ID
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