Organization
ST LUKES REGIONAL MEDICAL CENTER
Active
Other names
ST LUKES INTERNAL MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
CARRIE LYNNE COWGILL (CREDENTIALING COORDINATOR)
(208) 381-4137
Entity
Organization
Contact information
Practice address
4840 N CLOVERDALE RD, BOISE, ID 83713-2423
(208) 706-8000
(208) 706-8001
Mailing address
PO BOX 550, BOISE, ID 83701-0550
(208) 706-8000
(208) 706-8001
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
06/07/2006
Last updated
10/31/2007
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