{"npi":"1376673137","type":"NPI-2","status":"active","name":{"display":"Glenns Ferry Health Center, Inc.","other":[],"organization_name":"GLENNS FERRY HEALTH CENTER, INC.","authorised_official":"Amber Jordan"},"specialty":{"primary_taxonomy":"261QF0400X","primary_taxonomy_description":"Federally Qualified Health Center","slug":"fqhc","schema_org_specialty":"PrimaryCare","all":[{"code":"261QF0400X","description":"Federally Qualified Health Center","primary":true,"state":"ID","license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"486 W 1ST AVE","city":"GLENNS FERRY","state":"ID","postal_code":"836232701","country_code":"US","phone":"2083667416","fax":"2085873324"},{"purpose":"MAILING","street_1":"120 DESERT SAGE WAY","city":"MOUNTAIN HOME","state":"ID","postal_code":"836471038","country_code":"US","phone":"2085873398","fax":"2085873324"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"002550500","state":"ID","issuer":null},{"type_code":"05","label":"Medicaid","value":"002550200","state":"ID","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20040119000307","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"ID","pac_id":"5496656894"},{"enrlmt_id":"O20060103000828","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"ID","pac_id":"5496656894"}]},"enumeration_date":"2007-03-07","last_updated":"2024-09-18","_meta":{"source":"NPPES","snapshot_date":"2024-09-18","doc_url":"https://findmynpi.com/api"}}