Organization
ST LUKES MEDICAL CENTER WOODRIVER LTD
Active
Other names
ST LUKES WOODRIVER INTERNAL MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE JENSEN (DIRECTOR)
(208) 727-8401
Entity
Organization
Contact information
Practice address
100 HOSPITAL DRIVE, KETCHUM, ID 83340
(208) 788-2222
Mailing address
PO BOX 1098, BOISE, ID 83701-1098
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
62
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62
HOSPITAL STATE LICENSE #
ID
Enumeration date
01/22/2007
Last updated
08/22/2020
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