Provider Demographics
| NPI: | 1235279217 |
|---|---|
| Name: | FAMILY HEALTH SERVICES CORPORATION |
| Entity type: | Organization |
| Organization Name: | FAMILY HEALTH SERVICES CORPORATION |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | AARON |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | HOUSTON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 208-734-3312 |
| Mailing Address - Street 1: | 794 EASTLAND DR |
| Mailing Address - Street 2: | |
| Mailing Address - City: | TWIN FALLS |
| Mailing Address - State: | ID |
| Mailing Address - Zip Code: | 83301-6856 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 208-734-3312 |
| Mailing Address - Fax: | 208-734-5036 |
| Practice Address - Street 1: | 794 EASTLAND DR |
| Practice Address - Street 2: | |
| Practice Address - City: | TWIN FALLS |
| Practice Address - State: | ID |
| Practice Address - Zip Code: | 83301-6856 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 208-734-3312 |
| Practice Address - Fax: | 208-734-3313 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-02-07 |
| Last Update Date: | 2021-03-17 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| ID | 101Y00000X, 103T00000X, 124Q00000X, 133V00000X, 1041C0700X, 122300000X, 207Q00000X, 363A00000X, 363L00000X, 261QF0400X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | Group - Multi-Specialty |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 124Q00000X | Dental Providers | Dental Hygienist | Group - Multi-Specialty | |
| No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 122300000X | Dental Providers | Dentist | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| ID | 002547001 | Medicaid | |
| ID | 002547000 | Medicaid | |
| ID | 002547002 | Medicaid | |
| ID | 002547003 | Medicaid | |
| ID | 002547005 | Medicaid | |
| ID | 002547004 | Medicaid | |
| ID | 002547006 | Medicaid | |
| ID | 002547005 | Medicaid | |
| ID | 131818 | Medicare Oscar/Certification | |
| ID | 131812 | Medicare Oscar/Certification | |
| ID | 002547001 | Medicaid | |
| ID | 002547004 | Medicaid | |
| ID | 002547000 | Medicaid | |
| ID | 002547006 | Medicaid | |
| ID | 1374810 | Medicare Oscar/Certification | |
| ID | 1374814 | Medicare Oscar/Certification | |
| ID | 002547002 | Medicaid | |
| ID | 1374811 | Medicare Oscar/Certification | |
| ID | 1374812 | Medicare Oscar/Certification | |
| ID | 131383 | Medicare Oscar/Certification |
