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NPI Code Detail

MEDICARE: ST LUKES REGIONAL MEDICAL CENTER

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
1261QM2500XMedical Specialty Clinic/Center

General Provider Information

NPI Number : 1013957471
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST LUKES REGIONAL MEDICAL CENTER
Provider Business Mailing Address
First Line : PO BOX 550
Second Line :
City : BOISE
State : ID
Zip : 83701-0550
Country : US
Telephone Number : 208-706-8000
Fax Number : 208-706-8001
Provider Business Practice Location Address
First Line : 4840 N CLOVERDALE RD
Second Line :
City : BOISE
State : ID
Zip : 83713-2423
Country : US
Telephone Number : 208-706-8000
Fax Number : 208-706-8001
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : CARRIE LYNNE COWGILL
Credential :
Telephone Number : 208-381-4137
Provider Enumeration Date : 06/07/2006
Last Update Date : 10/31/2007

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Directions to “ST LUKES REGIONAL MEDICAL CENTER ” Practice Location

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