1245371863 NPI number — ST LUKES REGIONAL MEDICAL CENTER

Table of content: (NPI 1245371863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245371863 NPI number — ST LUKES REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST LUKES REGIONAL MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST LUKES ELMORE PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245371863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
895 N 6TH E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MTN HOME
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83647-2207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-587-8401
Provider Business Practice Location Address Fax Number:
208-587-8406
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CURTIS
Authorized Official First Name:
KELLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF PHARMACY OFFICER
Authorized Official Telephone Number:
208-493-2307

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1302582 . This is a "NCPDP NUMBER" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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