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Organization

ST LUKE'S REGIONAL MEDICAL CENTER

Active
Parent organization
ST LUKE'S REGIONAL MEDICAL CENTER
Other names
ST LUKE'S CHILDRENS - NEUROLOGY
Organization subpart
Yes

Provider details

NPI number
Legal business name
ST LUKE'S REGIONAL MEDICAL CENTER
Authorized official
JOHN KEE (VP PHYSICIAN SERVICES)
(208) 381-5329
Entity
Organization

Contact information

Practice address
100 E IDAHO ST, STE 200, BOISE, ID 83712-6267
(208) 381-5000
(208) 381-5005
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222

Taxonomy

Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
03
ID
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
Primary
03
ID

Other

Enumeration date
02/09/2011
Last updated
02/09/2011
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