NPI age
10 years
Enumerated 2015-08-10
● Active Type 2 · Organization
Shoshone Bannock Tribes, Inc
Shoshone Bannock Tribes, Inc is 1 of 145 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Plus 1 secondary
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Johnson
Credentialing Manager
Last NPPES update
2022-01-19
Source: monthly bulk 2026-05
How this organization compares
Across 145 active clinic/center providers in Idaho.
NPI age
10 years
≈ at median (9 yr)
Practice locations
1
0 secondary on file
Subspecialties
1
In the 9% of peers with subspecialties
NPI lifetime · 2015 → 2026
2015-08Enumerated in NPPES
2015
2026
Where they practice
Primary practice location
Navajo Drive Bldg 70
Fort Hall, ID 832030306
Mailing address
Po Box 306
Fort Hall, ID 832030306
Authorized official
Melissa M Johnson
Credentialing Manager
📞 5178963464
Specialties
-
Clinic/Center PrimaryA facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct...
-
Clinic/CenterDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1225414519 |
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Shoshone-Bannock Community Health Center
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 →
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