NPI age
19 years
Enumerated 2007-05-17
● Active Type 2 · Organization
Shoshone Bannock Tribes
Shoshone Bannock Tribes is 1 of 68 podiatrist organizations in Idaho.
Primary specialty
Podiatrist
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Mendez
Tribal Health Director
Last NPPES update
2020-08-22
Source: monthly bulk 2026-05
How this organization compares
Across 68 active podiatrist providers in Idaho.
NPI age
19 years
≈ at median (19 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2007 → 2026
2007-05Enumerated in NPPES
2007
2026
Where they practice
Primary practice location
717 Mission Road
Fort Hall, ID 83203
Mailing address
Po Box 306, Pima Drive
Fort Hall, ID 832030306
Authorized official
Angela Mendez
Tribal Health Director
📞 2084783994
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
-
Podiatrist PrimaryA podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 8066486 |
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
SHOSHONE BANNOCK CLINIC PODIATRY GROUP
Practice context
Multi-provider organization. 5 individual providers on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.