Provider Demographics
NPI:1598508053
Name:POCATELLO FREE CLINIC
Entity type:Organization
Organization Name:POCATELLO FREE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-233-6245
Mailing Address - Street 1:1001 N 7TH AVE N STE 155
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5786
Mailing Address - Country:US
Mailing Address - Phone:208-233-6245
Mailing Address - Fax:208-233-1065
Practice Address - Street 1:1001 N 7TH AVE N STE 155
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5786
Practice Address - Country:US
Practice Address - Phone:208-233-6245
Practice Address - Fax:208-233-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty