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General NPI Number Information
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NPI Number | 1043528011
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Entity Type | Organization
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Legal Business Name | ST LUKES MCCALL, LTD
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 1000 STATE ST
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City | MCCALL
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State | ID
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Zip | 83638-3704
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Country | US
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Telephone | 208-634-4061
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2777
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City | BOISE
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State | ID
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Zip | 83701-2777
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Country | US
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Telephone | 208-706-5000
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Fax |
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Authorized Official
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Title or Position | SENIOR VP, CFO
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Name | KATHRYN FOWLER
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Credential |
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Telephone | 208-381-8717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | 11
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License Number State | ID
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