Healthcare Provider Details

I. General information

NPI: 1124331822
Provider Name (Legal Business Name): ST LUKES REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E IDAHO ST STE 302
BOISE ID
83712-6267
US

IV. Provider business mailing address

100 E IDAHO ST STE 302
BOISE ID
83712-6267
US

V. Phone/Fax

Practice location:
  • Phone: 208-343-7501
  • Fax:
Mailing address:
  • Phone: 208-343-7501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number03
License Number StateID

VIII. Authorized Official

Name: JOHN KEE
Title or Position: VP PHYSICIAN SERVICES
Credential:
Phone: 208-381-5329