Organization
ST LUKES MCCALL LTD
Active
Parent organization
ST LUKES MCCALL LTD
Other names
St Lukes Payette Lakes Medical Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST LUKES MCCALL LTD
Authorized official
JEFF TAYLOR (SYSTEM VP CFO)
(208) 381-2520
Entity
Organization
Contact information
Practice address
211 FOREST ST, MCCALL, ID 83638-5256
(208) 634-2225
Mailing address
1000 STATE ST, MCCALL, ID 83638-3704
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11
ID
207QA0000X
Adolescent Medicine (Family Medicine) Physician
11
ID
207QA0505X
Adult Medicine Physician
11
ID
Other
Enumeration date
02/16/2012
Last updated
02/16/2012
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