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General NPI Number Information
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NPI Number | 1053092130
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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 | 07/31/2023
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 703 S BLACK CAT RD STE 120
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City | MERIDIAN
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State | ID
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Zip | 83642-6103
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Country | US
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Telephone | 208-381-6161
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Fax | 208-381-6160
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Provider Business Mailing Address
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Address Line | PO BOX 640
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City | BOISE
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State | ID
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Zip | 83701-0640
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Country | US
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Telephone | 208-381-6161
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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 | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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