Provider Demographics
NPI:1366630949
Name:BMH INC
Entity Type:Organization
Organization Name:BMH INC
Other - Org Name:PHYSICIANS AND SURGEONS OF SHELLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
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 1:275 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:SHELLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83274-1230
Mailing Address - Country:US
Mailing Address - Phone:208-782-2960
Mailing Address - Fax:
Practice Address - Street 1:275 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:SHELLEY
Practice Address - State:ID
Practice Address - Zip Code:83274-1230
Practice Address - Country:US
Practice Address - Phone:208-782-2960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BMH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-09
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID36261QR1300X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8N304OtherBLUE CROSS OF IDAHO
ID807947000Medicaid
ID000010137702OtherBLUE SHIELD OF IDAHO