NPI age
6 years
Enumerated 2020-05-05
● Active Type 2 · Organization
Idaho Street Medical Clinic
Idaho Street Medical Clinic is 1 of 55 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Roe
Nurse Practitioner
Last NPPES update
2020-05-05
Source: monthly bulk 2026-05
How this organization compares
Across 55 active clinic/center providers in Idaho.
NPI age
6 years
↓ 3 yr below median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2020 → 2026
2020-05Enumerated in NPPES
2020
2026
Where they practice
Primary practice location
126 W. Idaho Ave
Homedale, ID 836288362
Mailing address
24900 Market Rd
Parma, ID 836606723
Authorized official
Edith Mary Roe, NP-BC
Nurse Practitioner
📞 2088594103
Specialties
-
Clinic/Center PrimaryDefinition to come...
Practice context
Single-site organization. Only one practice location on file.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.