Organization
ST LUKE'S MCCALL LTD
Active
Parent organization
ST LUKE'S MCCALL LTD
Other names
St Luke's Payette Lakes Medical Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST LUKE'S MCCALL LTD
Authorized official
JEFF TAYLOR (SYSTEM VP CFO)
(208) 381-2520
Entity
Organization
Contact information
Practice address
211 FOREST ST, MCCALL, ID 83638-5256
(208) 634-2225
Mailing address
211 FOREST ST, MCCALL, ID 83638-5256
(208) 634-2225
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11
ID
207V00000X
Obstetrics & Gynecology Physician
11
ID
363L00000X
Nurse Practitioner
11
ID
Other
Enumeration date
12/21/2010
Last updated
12/21/2010
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