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General NPI Number Information
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NPI Number | 1912748013
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Entity Type | Organization
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Legal Business Name | ST LUKES MAGIC VALLEY REGIONAL MEDICAL CENTER LTD
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 815 N COLLEGE RD STE 150
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City | TWIN FALLS
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State | ID
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Zip | 83301-3484
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Country | US
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Telephone | 208-814-9250
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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 | 208-205-7779
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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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