Healthcare Provider Details

I. General information

NPI: 1134166820
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: 06/01/2006
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 POLE LINE RD
TWIN FALLS ID
83301-4085
US

IV. Provider business mailing address

PO BOX 2777
BOISE ID
83701-2777
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-7600
  • Fax:
Mailing address:
  • Phone: 208-814-7400
  • Fax: 208-814-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateID

VIII. Authorized Official

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