Organization
ST LUKES REGIONAL MEDICAL CENTER
Active
Other names
ST LUKES DEVELOPMENTAL PEDIATRICS
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY HIRSCHFELD (ADMINISTRATOR)
(208) 381-2818
Entity
Organization
Contact information
Practice address
100 E IDAHO ST, STE 200, BOISE, ID 83712-6223
(208) 381-7312
Mailing address
PO BOX 550, BOISE, ID 83701-0550
(208) 381-7312
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
03
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03
HOSPITAL STATE LIC #
ID
Enumeration date
03/19/2007
Last updated
08/22/2020
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