ST BENEDICTS FAMILY MEDICAL CENTER (NPI# 1922037530) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922037530 |
| Entity Type | Organization |
| Organization Name | ST BENEDICTS FAMILY MEDICAL CENTER |
| Other Organization Name | FIFTH AVENUE CLINIC |
| Practice Address |
115 5th Ave W Jerome ID 83338-1824 |
| Practice Telephone | 2083248831 |
| Practice Fax Number | 2083246678 |
| Mailing Telephone | 2083248831 |
| Mailing Fax Number | 2083246678 |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2008-05-08 |
| Authorized Official Name | MR. WARREN ALAN STEVENSON (CEO) |
| Authorized Official Telephone | 2083241122 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
ID | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | BLUE CROSS OF IDAHO | 8A489 | 01 |
| ID | 807893400 | 05 | |
| ID | REGENCE BLUE SHIELD OF ID | 000010006293 | 01 |
| ID | 002287100 | 05 |
| Other Name | Type Code |
|---|---|
| FIFTH AVENUE CLINIC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992898605 | St Benedicts Family Medical Center | Home Health | 414 N Lincoln, Suite 1, Jerome, ID 83338 | 2006-10-02 |
| 1073559993 | St Benedicts Family Medical Center | Clinic/Center | 280 W Main St, Wendell, ID 83355-5201 | 2006-06-20 |
| 1902856727 | St Benedicts Family Medical Center | Skilled Nursing Facility | 709 N Lincoln Ave, Jerome, ID 83338-1851 | 2006-05-11 |
| Street Address |
115 5TH AVE W |
| City | JEROME |
| State | ID |
| Zip Code | 83338-1824 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295336709 | Family Health Services Pharmacy | Pharmacy | 218 W. Nez Perce, Jerome, ID 83338 | 2020-11-03 |
| 1811391626 | Summit Therapy Services | In Home Supportive Care | 113 East Ave. F, Jerome, ID 83338 | 2014-10-22 |
| 1952645285 | Readings Community Pharmacy Inc | Pharmacy | 133 West A, Jerome, ID 83338 | 2012-11-27 |
| 1801121298 | Yolanda S. Sedano | Physician Assistant | 132 5th Ave West, Jerome, ID 83338 | 2009-10-02 |
| 1295898310 | Ronald Gail Hendrickson | Dentist | 128 South Adams, Jerome, ID 83338 | 2006-12-19 |
| 1316035512 | Johnson Chiropractic Clinic | Chiropractor | 600 N Lincoln Ave, Jerome, ID 83338 | 2006-10-11 |
| 1265527725 | Lon M. Egbert, P.C. | Specialist/Technologist | 128 5th Ave West, Jerome, ID 83338 | 2006-10-03 |
| 1992898605 | St Benedicts Family Medical Center | Home Health | 414 N Lincoln, Suite 1, Jerome, ID 83338 | 2006-10-02 |
| 1790231355 | Lexa Marie Balling | Pharmacist | 2680 S Lincoln Ave, Jerome, ID 83338 | 2016-09-01 |
| 1487218814 | Logan Perkins | Family Medicine | 132 5th Ave W Ste 2, Jerome, ID 83338-1825 | 2019-05-01 |
| Find all providers in zip 83338 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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| 1346799483 | Healing Sanctuary LLC | Clinic/Center | 187 E 13th St, Idaho Falls, ID 83404-5305 | 2016-09-30 |
| 1760741334 | Saint Alphonsus Regional Medical Center Inc | Clinic/Center | 131 Constitution Way, Nampa, ID 83686 | 2012-05-16 |
| 1750681607 | Family Services, Pllc | Clinic/Center | 501 N 16th St Ste 108, Payette, ID 83661-2782 | 2010-10-26 |
| 1043545106 | Ashwood Recovery LLC. | Clinic/Center | 7941 W Rifleman St, Boise, ID 83704-9001 | 2009-10-07 |
| 1659371870 | Saint Alphonsus Medical Center Nampa, Inc. | Clinic/Center | 4300 E Flamingo Ave, Nampa, ID 83687-3138 | 2005-07-29 |
| 1881200517 | Vannvei LLC | Clinic/Center | 1522 17th St, Lewiston, ID 83501-3652 | 2020-09-18 |
| 1831716182 | Regenesis Health Centre Inc. | Clinic/Center | 430 W Iowa Ave Ste A, Nampa, ID 83686-2826 | 2020-07-02 |
| 1568005809 | Pure Healthcare of Idaho LLC | Clinic/Center | 6560 W Emerald St Ste 122, Boise, ID 83704-8781 | 2019-10-18 |
| 1699316190 | Boise Plastic Surgery Boise Hand Center Pllc | Clinic/Center | 1070 N Curtis Rd Ste 135, Boise, ID 83706-1257 | 2019-10-05 |
| 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.