MEDICARE: ST LUKES REGIONAL MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1302582	OTHER	ID	NCPDP NUMBER

General Provider Information

NPI Number	:	1245371863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST LUKES REGIONAL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 2777
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83701-2777
Country	:	US
Telephone Number	:	208-493-2307
Fax Number	:

Provider Business Practice Location Address
First Line	:	895 N 6TH E
Second Line	:
City	:	MTN HOME
State	:	ID
Zip	:	83647-2207
Country	:	US
Telephone Number	:	208-587-8401
Fax Number	:	208-587-8406

Authorized Official
Title or Position	:	CHIEF PHARMACY OFFICER
Name	:	MRS. KELLEY CURTIS
Credential	:
Telephone Number	:	208-493-2307

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	03/30/2022

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Directions to “ST LUKES REGIONAL MEDICAL CENTER ” Practice Location

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