KEITH E DAVIS NPI 1972673218

NPI Information

  • NPI: 1972673218
  • Provider Name: KEITH E DAVIS
  • Classification: Clinic/Center - 261QR1300X
  • Specialization: Rural Health
  • Entity Type: Organization
  • Doing Business As: SHOSHONE FAMILY MEDICAL CENTER
  • CLIA Number: 13D0520769
  • Address: 113 S APPLE ST
    SHOSHONE, ID
    ZIP 83352
  • Phone: (208) 886-2222

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NPI Details

KEITH E DAVIS is a rural health clinic center in Shoshone, ID. KEITH E DAVIS NPI is 1972673218. The provider is registered as an organization entity type.
The provider Is Doing Business As Shoshone Family Medical Center.

The provider's business location address is:

113 S APPLE ST
SHOSHONE, ID
ZIP 83352-287
Phone: (208) 886-2222

The provider's authorized official is Keith E Davis .
The authorized official title is Owner and has the following contact phone number (208) 886-2224.

The CLIA number assigned to this NPI record is 13D0520769 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/8/2006 and was last updated on 3/8/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QR1300XClinic/CenterRural HealthYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11370207MEDICARE PINIDAHO
2806290300MEDICAIDIDAHO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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