MEDICARE: ST LUKES REGIONAL MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1013791797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST LUKES REGIONAL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 640
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83701-0640
Country	:	US
Telephone Number	:	208-205-7779
Fax Number	:	208-205-7778

Provider Business Practice Location Address
First Line	:	1118 NW 16TH ST STE 150
Second Line	:
City	:	FRUITLAND
State	:	ID
Zip	:	83619-2271
Country	:	US
Telephone Number	:	208-452-9890
Fax Number	:	208-452-9899

Authorized Official
Title or Position	:	CHIEF PHARMACY OFFICER
Name	:	KELLY CURTIS
Credential	:
Telephone Number	:	208-493-2307

Provider Enumeration Date	:	08/23/2023
Last Update Date	:	04/20/2026

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