Healthcare Provider Details

I. General information

NPI: 1932154705
Provider Name (Legal Business Name): ST. LUKE'S MAGIC VALLEY REGIONAL MEDICAL CENTER, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 POLE LINE RD W
TWIN FALLS ID
83301-5810
US

IV. Provider business mailing address

PO BOX 2777
BOISE ID
83701-2777
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-1000
  • Fax:
Mailing address:
  • Phone: 208-706-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number14
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN FOWLER
Title or Position: SENIOR VP, CFO
Credential:
Phone: 208-381-8717