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General NPI Number Information
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NPI Number | 1760203921
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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 | 10/21/2024
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 801 POLE LINE RD W
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City | TWIN FALLS
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State | ID
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Zip | 83301-5810
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Country | US
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Telephone | 208-814-1275
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Fax | 208-814-1276
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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 | 208-205-7779
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Fax | 208-205-7778
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Authorized Official
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Title or Position | CHIEF PHARMACY OFFICER
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Name | KELLY CURTIS
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Credential |
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Telephone | 208-493-2307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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