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General NPI Number Information
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NPI Number | 1861982456
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Entity Type | Organization
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Legal Business Name | ST LUKES CLINIC - TREASURE VALLEY LLC
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 5155 S HOWRY LANE
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-381-2222
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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 | 208-381-2222
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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 | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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