Organization
ST LUKES REGIONAL MEDICAL CENTER
Active
Parent organization
ST LUKES REGIONAL MEDICAL CENTER
Other names
ST LUKES CLINIC - GENERAL SURGERY
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST LUKES REGIONAL MEDICAL CENTER
Authorized official
JEFF TAYLOR CFO (SYSTEM VP CFO)
(208) 381-2520
Entity
Organization
Contact information
Practice address
3399 E LOUISE DR, STE 400, MERIDIAN, ID 83642-5047
(208) 364-3000
(208) 364-3191
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
03
ID
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
03
ID
Other
Enumeration date
12/14/2011
Last updated
12/14/2011
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