# ST LUKES REGIONAL MEDICAL CENTER DBA ST LUKE'S INTERNAL MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SLIM Midlevel Providers
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790983385
- **Authorized official:** MS. CARRIE LYNNE COWGILL (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (208) 381-4137

## Contact information

- **Practice address:** 300 E JEFFERSON ST, BOISE, ID 83712-6246
- **Practice address phone:** (208) 381-4100
- **Practice address fax:** (208) 381-4101
- **Mailing address:** PO BOX 550, BOISE, ID 83701-0550
- **Mailing address phone:** (208) 381-4100
- **Mailing address fax:** (208) 381-4101

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | — | NULL | Yes |
| 363A00000X | Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 07/05/2007
- **Last updated:** 08/22/2020