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General NPI Number Information
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NPI Number | 1003295452
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Entity Type | Organization
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Legal Business Name | ST LUKES REGIONAL MEDICAL CENTER
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Dates
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Enumeration Date | 05/19/2015
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 1226 W RIVER ST
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City | BOISE
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State | ID
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Zip | 83702-7049
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Country | US
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Telephone | 208-331-1155
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Fax |
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone | 208-381-2222
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Fax |
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Authorized Official
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Title or Position | SR VICE PRESIDENT AND CFO
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Name | JEFF TAYLOR
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Credential |
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Telephone | 208-381-2520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 03
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 03
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License Number State | ID
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