OrganizationActive
Southern Idaho Diabetes Education Program
NPI 1154572311 · Primary Care Clinic/Center · Shoshone, ID
Provider details
- NPI number
- 1154572311
- Entity type
- Organization
- Primary specialty
- Primary Care Clinic/CenterAmbulatory Health Care Facilities
- Parent organization
- Shoshone Family Medical Center
- Organization subpart
- Yes
- Authorized official
- Kathryn Pike, Sidep Coordinator(208) 944-4747
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
108 Nw Rail St
Shoshone, ID 83352
Phone: (208) 944-4747
Fax: (208) 886-2634
Approximate (ZIP-level) locationGet directions
Mailing address
113 S Apple St
Shoshone, ID 83352-5287
Registry dates
- Enumerated
- 2008-10-07
- Last updated
- 2008-10-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.