Organization
ST LUKES REGIONAL MEDICAL CENTER DBA ST LUKE'S INTERNAL MEDICINE
Active
Other names
SLIM Midlevel Providers
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CARRIE LYNNE COWGILL (CREDENTIALING COORDINATOR)
(208) 381-4137
Entity
Organization
Contact information
Practice address
300 E JEFFERSON ST, BOISE, ID 83712-6246
(208) 381-4100
(208) 381-4101
Mailing address
PO BOX 550, BOISE, ID 83701-0550
(208) 381-4100
(208) 381-4101
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
07/05/2007
Last updated
08/22/2020
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