Organization
ST LUKE'S HUMPHREYS DIABETES CENTER INC
Active
Other names
Humphreys Diabetes Center INC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT SCANLON (EXECUTIVE DIRECTOR)
(208) 331-1155
Entity
Organization
Contact information
Practice address
1226 W RIVER ST, BOISE, ID 83702-7049
(208) 331-1155
(208) 383-0190
Mailing address
1226 W RIVER ST, BOISE, ID 83702-7049
(208) 331-1155
(208) 383-0190
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
4366980001
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010013347
BLUE SHIELD
ID
01
—
000010170136
REGENCE WALTERS
ID
05
—
806348400
—
ID
05
—
807850000
—
ID
01
—
8G502
BLUE CROSS
ID
Enumeration date
02/01/2007
Last updated
07/28/2011
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