Healthcare Provider Details

I. General information

NPI: 1134922339
Provider Name (Legal Business Name): ST LUKES REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 W EXECUTIVE DR
BOISE ID
83713-0803
US

IV. Provider business mailing address

PO BOX 640
BOISE ID
83701-0640
US

V. Phone/Fax

Practice location:
  • Phone: 208-205-7779
  • Fax: 208-205-7780
Mailing address:
  • Phone: 208-205-7779
  • Fax: 208-205-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

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