1780117259 NPI number — ST LUKES NAMPA MEDICAL CENTER LTD

Table of content: (NPI 1780117259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780117259 NPI number — ST LUKES NAMPA MEDICAL CENTER LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST LUKES NAMPA MEDICAL CENTER LTD
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:
Provider Other Organization Name Type Code:
6
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:
1780117259
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
190 E BANNOCK ST
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:
83712-6241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-381-4353
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9850 W ST LUKES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAMPA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83687-7912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-381-4353
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2017

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

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

  • Identifier: 20022717 . This is a "MEDICARE - PART B VACCINES" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 7676920001 . This is a "MEDICARE - O/P PHARMACY" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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