# ST LUKES MCCALL LTD

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ST LUKES MCCALL LTD
- **Other names:** St Lukes Payette Lakes Medical Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1245503614
- **Legal business name:** ST LUKES MCCALL LTD
- **Authorized official:** JEFF TAYLOR (SYSTEM VP CFO)
- **Authorized official phone:** (208) 381-2520

## Contact information

- **Practice address:** 211 FOREST ST, MCCALL, ID 83638-5256
- **Practice address phone:** (208) 634-2225
- **Mailing address:** 1000 STATE ST, MCCALL, ID 83638-3704
- **Mailing address phone:** (208) 381-2222

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 11 | ID | Yes |
| 207QA0000X | Adolescent Medicine (Family Medicine) Physician | 11 | ID | — |
| 207QA0505X | Adult Medicine Physician | 11 | ID | — |

## Other

- **Enumeration date:** 02/16/2012
- **Last updated:** 02/16/2012