# ST LUKES REGIONAL MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ST LUKES INTERNAL MEDICINE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013957471
- **Authorized official:** CARRIE LYNNE COWGILL (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (208) 381-4137

## Contact information

- **Practice address:** 4840 N CLOVERDALE RD, BOISE, ID 83713-2423
- **Practice address phone:** (208) 706-8000
- **Practice address fax:** (208) 706-8001
- **Mailing address:** PO BOX 550, BOISE, ID 83701-0550
- **Mailing address phone:** (208) 706-8000
- **Mailing address fax:** (208) 706-8001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/07/2006
- **Last updated:** 10/31/2007