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General NPI Number Information
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NPI Number | 1780793596
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Entity Type | Organization
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Legal Business Name | ST LUKE'S REGIONAL MEDICAL CENTER
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 09/30/2016
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Provider Practice Location Address
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Address Line | 520 S EAGLE RD STE 3112
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City | MERIDIAN
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State | ID
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Zip | 83642-6351
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Country | US
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Telephone | 208-706-5800
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Fax |
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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 | 208-381-2222
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Fax |
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Authorized Official
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Title or Position | SR VP/CFO
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Name | JEFF TAYLOR
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Credential |
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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 | 2088F0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
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License Number | 03
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | 03
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 03
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License Number State | ID
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