Healthcare Provider Details

I. General information

NPI: 1760203921
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: 10/21/2024
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
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 640
BOISE ID
83701-0640
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-1275
  • Fax: 208-814-1276
Mailing address:
  • Phone: 208-205-7779
  • Fax: 208-205-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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