Organization
ST LUKES REGIONAL MED CTR DBA ST LUKES PEDIATRIC SURGERY OF IDAHO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CARRIE L COWGILL (CREDENTIALING COORDINATOR)
(208) 381-4137
Entity
Organization
Contact information
Practice address
100 E IDAHO ST, SUITE 300, BOISE, ID 83712-6223
(208) 345-5400
(208) 345-5454
Mailing address
100 E IDAHO ST, SUITE 300, BOISE, ID 83712-6223
(208) 345-5400
(208) 345-5454
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
—
—
Other
Enumeration date
04/18/2007
Last updated
04/09/2008
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