Organization
ST LUKES REGIONAL MEDICAL CENTER
Active
Other names
St Luke's Humphreys Diabetes Center
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF TAYLOR (SR VICE PRESIDENT AND CFO)
(208) 381-2520
Entity
Organization
Contact information
Practice address
1226 W RIVER ST, BOISE, ID 83702-7049
(208) 331-1155
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
03
ID
163WD0400X
Diabetes Educator Registered Nurse
Primary
03
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003295452
—
ID
Enumeration date
05/19/2015
Last updated
06/22/2016
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