Healthcare Provider Details

I. General information

NPI: 1013791797
Provider Name (Legal Business Name): ST LUKES REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 NW 16TH ST STE 150
FRUITLAND ID
83619-2271
US

IV. Provider business mailing address

PO BOX 640
BOISE ID
83701-0640
US

V. Phone/Fax

Practice location:
  • Phone: 208-452-9890
  • Fax: 208-452-9899
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: KELLY CURTIS
Title or Position: CHIEF PHARMACY OFFICER
Credential:
Phone: 208-493-2307