COMMUNITY COUNCIL OF IDAHO, INC. (NPI# 1356416861) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356416861 |
| Entity Type | Organization |
| Organization Name | COMMUNITY COUNCIL OF IDAHO, INC. |
| Other Organization Name | COMMUNITY FAMILY CLINIC |
| Practice Address |
625 W Pacific St Suite 3 Blackfoot ID 83221-2034 |
| Mailing Address |
2088 E 25th St Idaho Falls ID 83404-6490 |
| Practice Telephone | 2087820500 |
| Mailing Telephone | 2085287655 |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2009-08-12 |
| Authorized Official Name | IRMA MORIN (ADMINISTRATION) |
| Authorized Official Telephone | 2084533020 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Community Family Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740356633 | Community Council of Idaho, Inc. | Family Medicine | 651n 2858e, Roberts, ID 83404 | 2006-11-24 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | COMMUNITY COUNCIL OF IDAHO, INC. | 315 Happy Day Blvd Ste 120, Caldwell, ID 83607 |
| Street Address |
625 W PACIFIC ST SUITE 3 |
| City | BLACKFOOT |
| State | ID |
| Zip Code | 83221-2034 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588837496 | Damon T. Armstrong D.d.s., P.c | Dentist | 625 W Pacific St, Suite #4, Blackfoot, ID 83221-2034 | 2008-04-11 |
| 1407074636 | Childrens Supportive Services Incorporated | Community/Behavioral Health | 625 W Pacific St, Suite 2, Blackfoot, ID 83221-2034 | 2007-04-23 |
| 1467679035 | Childrens Supportive Services Incorporated | Community/Behavioral Health | 625 W Pacific St, Suite 2, Blackfoot, ID 83221-2034 | 2007-04-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932711165 | Samantha Paige Averett | Social Worker | 60 N Broadway, Blackfoot, ID 83221 | 2020-08-19 |
| 1730711656 | Sara Marie Letham | Family Medicine | 33 S Thompson Lane, Blackfoot, ID 83221 | 2020-02-08 |
| 1962994962 | Tyler Thomas Wood | Student in an Organized Health Care Education/Training Program | 98 Poplar Street, Blackfoot, Id 83221, Blackfoot, ID 83221 | 2018-06-05 |
| 1801336276 | Bmh, Inc. | Internal Medicine | 235 Poplar St, Blackfoot, ID 83221 | 2017-03-03 |
| 1497119804 | Susan Doran | Social Worker | 720 E. Alice, Blackfoot, ID 83221 | 2016-04-12 |
| 1427412121 | Josie Russell Adkins | Counselor | 720 East Alice, Blackfoot, ID 83221 | 2016-04-08 |
| 1740590314 | Ashley Nichole Thomas | Physician Assistant | 710 E. Alice Street, Blackfoot, ID 83221 | 2010-10-18 |
| 1528373313 | Stephanie Lynn Henderson | Dietitian, Registered | 1555 Vernon Ave, Blackfoot, ID 83221 | 2010-08-17 |
| 1184850141 | Joy H. Taylor | Nurse Practitioner | 1441 Parkway Drive, Blackfoot, ID 83221 | 2009-06-04 |
| 1427232925 | Nathan E. Sneddon | Anesthesiology | 98 Poplar St Fl 3, Blackfoot, ID 83221 | 2007-12-20 |
| Find all providers in zip 83221 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 1043794001 | Community Health Clinics, Inc. | Clinic/Center | 506 Fletcher Dr, Nampa, ID 83686-8854 | 2018-09-17 |
| 1972082675 | Community Health Clinics, Inc. | Clinic/Center | 1670 N Linder Rd, Kuna, ID 83634-3032 | 2018-08-13 |
| 1841779667 | Community Health Clinics, Inc. | Clinic/Center | 610 N School Ave, Kuna, ID 83634-1807 | 2018-08-13 |
| 1225517055 | Community Health Clinics, Inc. | Clinic/Center | 4085 E Greenhurst Rd, Nampa, ID 83686-8657 | 2018-08-13 |
| 1982183687 | Community Health Clinics, Inc. | Clinic/Center | 301 S Happy Valley Rd, Nampa, ID 83687-8828 | 2018-08-13 |
| 1396249546 | Community Health Clinic Inc. | Clinic/Center | 521 Carrie Rex, Melba, ID 83641 | 2018-03-22 |
| 1912401381 | Community Health Clinic Inc. | Clinic/Center | 700 N Star Rd, Star, ID 83669-5417 | 2018-03-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.