NPI age
19 years
Enumerated 2007-01-22
● Active Type 2 · Organization
Subpart
Shoshone Bannock Tribes, Inc
Shoshone Bannock Tribes, Inc is 1 of 145 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Mendez
Tribal Health Director
Last NPPES update
2010-01-25
Source: monthly bulk 2026-05
How this organization compares
Across 145 active clinic/center providers in Idaho.
NPI age
19 years
↑ 10 yr above median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2007 → 2026
2007-01Enumerated in NPPES
2007
2026
Where they practice
Primary practice location
717 Mission Road
Fort Hall, ID 832030306
Mailing address
Po Box 306
Fort Hall, ID 832030306
Authorized official
Angela Mendez
Tribal Health Director
📞 2084783744
Individual providers at this organization
5 individual providers on file at this primary practice address.
- Thayne Andersen, LCSW Social Worker NPI 1194909952
- Ashley Ballensky, RN Registered Nurse NPI 1831442482
- Chantelle Bowman, PA-C Physician Assistant NPI 1063740082
- Daniel Hall, LCSW Social Worker NPI 1366847428
- Matthew Wadsworth, LCSW Social Worker NPI 1972759017
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...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 002264100 | |
| 05 (ID) | 003399100 | |
| 05 (ID) | 8063500 | |
| 05 (ID) | 8064977 | |
| 05 (ID) | 806648600 | |
| 05 (ID) | 80662922 |
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Shoshone Bannock Clinic
Practice context
Multi-provider organization. 5 individual providers on file at this primary address.
Subpart of Shoshone Bannock Tribes, Inc.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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