| Organization Name: | BENEWAH MEDICAL CENTER |
| NPI Number: | 1336135136 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GINGER CARPENTER (EXECUTIVE DIRECTOR) |
| Mailing Address: | 1115 B Street Plummer |
| State: | ID US |
| Postal Code: | 83851 |
| Phone Number: | 2086861931 |
| Fax Number: | 2086861146 |
| NPI Enumeration Date: | 09/27/2005 |
| NPI Last Update Date: | 06/17/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | 131814 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |