Organization
ST LUKES IDAHO CARDIOLOGY ASSOCIATES
Active
Organization
ST LUKES IDAHO CARDIOLOGY ASSOCIATES
Active
Parent organization
GRANDE RONDE HOSPITAL, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRANDE RONDE HOSPITAL, INC
Authorized official
MR. JAMES A MATTES (PRESIDENT/CEO)
(541) 963-1454
Entity
Organization
Contact information
Practice address
315 E ELM ST, SUITE 350, CALDWELL, ID 83605-4857
(208) 454-6363
Mailing address
900 SUNSET DR, PO BOX 3290, LA GRANDE, OR 97850-1362
(541) 963-1555
(541) 963-1845
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
140728
OR
Other
Enumeration date
04/13/2011
Last updated
04/13/2011
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