Healthcare Provider Details

I. General information

NPI: 1871218552
Provider Name (Legal Business Name): ST LUKES REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 N CLOVERDALE RD STE P
BOISE ID
83713-2423
US

IV. Provider business mailing address

PO BOX 640
BOISE ID
83701-0640
US

V. Phone/Fax

Practice location:
  • Phone: 208-706-8170
  • Fax: 208-706-8171
Mailing address:
  • Phone: 208-205-7779
  • Fax: 208-205-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: KELLEY CURTIS
Title or Position: CHIEF PHARMACY OFFICER
Credential:
Phone: 208-493-2307