1336238211 NPI number — COUNTY OF BENEWAH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336238211 NPI number — COUNTY OF BENEWAH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF BENEWAH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336238211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 S 9TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST MARIES
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83861-1704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-245-5304
Provider Business Mailing Address Fax Number:
208-245-5305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 S 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST MARIES
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83861-1704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-245-5304
Provider Business Practice Location Address Fax Number:
208-245-5305
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COMPTON
Authorized Official First Name:
KRISTIN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
UNIT DIRECTOR
Authorized Official Telephone Number:
208-245-5304

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  7113 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002807000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: E-0138 . This is a "BLUE CROSS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010014388 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 826000256 83861 0000 . This is a "TRICARE INSURANCE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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