Provider Demographics
NPI:1245779412
Name:BMH, INC.
Entity Type:Organization
Organization Name:BMH, INC.
Other - Org Name:BINGHAM MEMORIAL SPECIALTY CLINIC - VISTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-785-3801
Mailing Address - Street 1:98 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-1758
Mailing Address - Country:US
Mailing Address - Phone:208-782-3969
Mailing Address - Fax:208-782-2984
Practice Address - Street 1:285 VISTA DR
Practice Address - Street 2:STE. E
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4987
Practice Address - Country:US
Practice Address - Phone:208-239-8023
Practice Address - Fax:208-232-0369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID208200000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1366769Medicare PIN