# ST LUKE'S REGIONAL MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ST LUKE'S REGIONAL MEDICAL CENTER
- **Other names:** St Lukes Mountain States Urology
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1780793596
- **Legal business name:** ST LUKE'S REGIONAL MEDICAL CENTER
- **Authorized official:** JEFF TAYLOR (SR VP/CFO)
- **Authorized official phone:** (208) 381-2520

## Contact information

- **Practice address:** 520 S EAGLE RD, STE 3112, MERIDIAN, ID 83642-6351
- **Practice address phone:** (208) 706-5800
- **Mailing address:** PO BOX 640, BOISE, ID 83701-0640
- **Mailing address phone:** (208) 381-2222

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 03 | ID | Yes |
| 2088F0040X | Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician | 03 | ID | — |
| 2088P0231X | Pediatric Urology Physician | 03 | ID | — |

## Other

- **Enumeration date:** 08/29/2006
- **Last updated:** 09/30/2016