Organization
ST LUKE'S REGIONAL MEDICAL CENTER
Active
Parent organization
ST LUKE'S REGIONAL MEDICAL CENTER
Other names
ST LUKE'S CLINIC - IDAHO PEDIATRIC GASTROENTEROLOGY
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST LUKE'S REGIONAL MEDICAL CENTER
Authorized official
JEFF TAYLOR (SYSTEM VP CFO)
(208) 381-2520
Entity
Organization
Contact information
Practice address
100 E IDAHO ST, STE 316, BOISE, ID 83712-6267
(208) 381-7310
Mailing address
100 E IDAHO ST, STE 316, BOISE, ID 83712-6267
(208) 381-7310
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
03
ID
Other
Enumeration date
11/04/2010
Last updated
11/04/2010
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