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Organization

ST LUKE'S REGIONAL MEDICAL CENTER

Active
Parent organization
ST LUKE'S REGIONAL MEDICAL CENTER
Other names
St Lukes Mountain States Urology
Organization subpart
Yes

Provider details

NPI number
Legal business name
ST LUKE'S REGIONAL MEDICAL CENTER
Authorized official
JEFF TAYLOR (SR VP/CFO)
(208) 381-2520
Entity
Organization

Contact information

Practice address
520 S EAGLE RD, STE 3112, MERIDIAN, ID 83642-6351
(208) 706-5800
Mailing address
PO BOX 640, BOISE, ID 83701-0640
(208) 381-2222

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
03
ID
2088F0040X
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
03
ID
2088P0231X
Pediatric Urology Physician
03
ID

Other

Enumeration date
08/29/2006
Last updated
09/30/2016
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