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General NPI Number Information
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NPI Number | 1134166820
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Entity Type | Organization
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Legal Business Name | ST. LUKE'S MAGIC VALLEY REGIONAL MEDICAL CENTER LTD
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 601 POLE LINE RD
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City | TWIN FALLS
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State | ID
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Zip | 83301-4085
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Country | US
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Telephone | 208-814-7600
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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 | 208-814-7400
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Fax | 208-814-7491
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | ID
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