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General NPI Number Information
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NPI Number | 1922042506
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Entity Type | Organization
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Legal Business Name | ST LUKES REGIONAL MEDICAL CENTER
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 07/14/2009
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Provider Practice Location Address
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Address Line | 300 E JEFFERSON ST
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City | BOISE
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State | ID
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Zip | 83712-6246
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Country | US
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Telephone | 208-381-4100
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Fax | 208-381-1665
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Provider Business Mailing Address
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Address Line | PO BOX 550
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City | BOISE
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State | ID
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Zip | 83701-0550
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Country | US
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Telephone | 208-381-4100
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Fax | 208-381-1665
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. GREG ORR
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Credential |
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Telephone | 208-381-4103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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