# ST LUKE'S MCCALL LTD

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ST LUKE'S MCCALL LTD
- **Other names:** St Luke's Payette Lakes Medical Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1770886384
- **Legal business name:** ST LUKE'S 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:** 211 FOREST ST, MCCALL, ID 83638-5256
- **Mailing address phone:** (208) 634-2225

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 11 | ID | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | 11 | ID | — |
| 363L00000X | Nurse Practitioner | 11 | ID | — |

## Other

- **Enumeration date:** 12/21/2010
- **Last updated:** 12/21/2010