Healthcare Provider Details

I. General information

NPI: 1447299342
Provider Name (Legal Business Name): ST LUKES REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E PARKCENTER BLVD
BOISE ID
83706-7539
US

IV. Provider business mailing address

PO BOX 550
BOISE ID
83701-0550
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-6400
  • Fax: 208-381-6450
Mailing address:
  • Phone: 208-381-4100
  • Fax: 208-381-1665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: CARRIE LYNNE COWGILL
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 208-381-4137