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General NPI Number Information
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NPI Number | 1366874877
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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 | 08/07/2013
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 709 N LINCOLN AVE
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City | JEROME
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State | ID
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Zip | 83338-1851
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Country | US
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Telephone | 208-324-4301
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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 | 208-324-4301
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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 | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 08
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License Number State | ID
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