Basic Information
| Provider Information | |||||||||
| NPI: | 1720487846 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. LUKE'S HEALTH SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 E BANNOCK ST | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837126241 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 190 E BANNOCK ST | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837126241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083812222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2014 | ||||||||
| LastUpdateDate: | 08/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | ONEIDA | ||||||||
| AuthorizedOfficialFirstName: | NICKOLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SITE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2083817187 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | D-827 | ID | Y | Hospitals | General Acute Care Hospital | Children |
No ID Information.