Organization
ST LUKES CLINIC-TREASURE VALLEY LLC
Active
Organization
ST LUKES CLINIC-TREASURE VALLEY LLC
Active
Parent organization
ST LUKES REGIONAL MEDICAL CENTER LTD
Other names
St Lukes Clinic - Trinity Mountain, St Lukes RHC - Trinity Mountain
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST LUKES REGIONAL MEDICAL CENTER LTD
Authorized official
KATHRYN FOWLER (SENIOR VP, CFO)
(208) 381-8717
Entity
Organization
Contact information
Practice address
840 N 4TH E, MOUNTAIN HOME, ID 83647-2166
(208) 587-1850
Mailing address
PO BOX 640, BOISE, ID 83701-0640
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
ID
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
ID
208000000X
Pediatrics Physician
—
ID
261QR1300X
Rural Health Clinic/Center
Primary
—
ID
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
133999
MEDICARE / RHC
ID
01
—
1369110
MEDICARE / MULTI SPECIALTY CLINIC
ID
Enumeration date
02/21/2013
Last updated
04/23/2026
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