1316980345 NPI number — ST LUKES REGIONAL MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316980345 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 INTERNAL MEDICINE
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:
1316980345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 550
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:
83701-0550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-706-5100
Provider Business Mailing Address Fax Number:
208-706-5169

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 3102
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:
208-706-5100
Provider Business Practice Location Address Fax Number:
208-706-5169
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COWGILL
Authorized Official First Name:
CARRIE
Authorized Official Middle Name:
LYNNE
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
208-381-4137

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com