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General NPI Number Information
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NPI Number | 1952348641
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Entity Type | Organization
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Legal Business Name | ST LUKES MAGIC VALLEY REGIONAL MEDICAL CENTER
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 05/11/2011
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Provider Practice Location Address
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Address Line | 801 POLELINE RD W
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City | TWIN FALLS
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State | ID
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Zip | 83301-5799
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Country | US
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Telephone | 208-814-7459
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Fax | 208-814-7491
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Provider Business Mailing Address
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Address Line | PO BOX 409
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City | TWIN FALLS
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State | ID
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Zip | 83303-0409
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Country | US
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Telephone | 208-814-7459
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Fax | 208-814-7459
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Authorized Official
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Title or Position | CEO
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Name | MR. JAMES ANGLE
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Credential |
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Telephone | 208-737-2101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | ID
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