Provider Demographics
NPI:1104351972
Name:SALMON RIVER CLINIC
Entity type:Organization
Organization Name:SALMON RIVER CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARCI
Authorized Official - Middle Name:
Authorized Official - Last Name:NEYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-490-3118
Mailing Address - Street 1:403 RIVERFRONT DR
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-5162
Mailing Address - Country:US
Mailing Address - Phone:208-742-1110
Mailing Address - Fax:208-742-1120
Practice Address - Street 1:403 RIVERFRONT DR
Practice Address - Street 2:
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-5162
Practice Address - Country:US
Practice Address - Phone:208-742-1110
Practice Address - Fax:208-742-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP1202A261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care