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General NPI Number Information
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NPI Number | 1336457738
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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 | 09/20/2010
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 209 FOREST ST
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City | MCCALL
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State | ID
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Zip | 83638-5256
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Country | US
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Telephone | 208-634-2221
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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 | 208-634-2221
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Fax |
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Authorized Official
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Title or Position | SYSTEM VP, CFO
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Name | JEFF TAYLOR
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Credential | CFO
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | ID
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | ID
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Taxonomy #6
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State | ID
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