1326040338 NPI number — ST. LUKE'S REGIONAL MEDICAL CENTER

Table of content: (NPI 1326040338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326040338 NPI number — ST. LUKE'S REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. LUKE'S 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 OUT PATIENT PHARMACY - MERIDIAN
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:
1326040338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 640
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:
83701-0640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 S EAGLE RD
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83642-6351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-706-5255
Provider Business Practice Location Address Fax Number:
208-706-5253
Provider Enumeration Date:
08/10/2005

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: 333600000X , with the licence number:  1145CP , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002253500 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1306011 . This is a "NABP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1145CP . This is a "PHARMACY LICENSE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 20022777 . This is a "MEDICARE - PART B VACCINES" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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