NPI age
7 years
Enumerated 2019-03-07
● Active Type 2 · Organization
Idaho Street Medical Clinic
Idaho Street Medical Clinic is 1 of 61 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
President
Last NPPES update
2019-03-07
Source: monthly bulk 2026-05
How this organization compares
Across 61 active clinic/center providers in Idaho.
NPI age
7 years
↓ 9 yr below median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2019 → 2026
2019-03Enumerated in NPPES
2019
2026
Where they practice
Primary practice location
126 Idaho Ave.
Homedale, ID 836288362
Mailing address
Po Box 37
Homedale, ID 836280037
Authorized official
Edith Roe, NURSE PRACTITIONER
President
📞 2088594103
Specialties
-
Clinic/Center PrimaryDefinition to come...
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Idaho Street Medical Clinic
Practice context
Single-site organization. Only one practice location on file.
Provyx · Custom healthcare lists
Need all 61 Clinic/Center providers in Idaho?
Get the full list as a CSV with verified work emails, direct phones, and LinkedIn URLs.
Request a quote →How to verify this organization
- 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.