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ST LUKE'S CLINIC LLC NPI 1790718229


NPI Information

NPI: 1790718229
Provider Name: ST LUKE'S CLINIC LLC

Doing Business As: ST LUKES CLINIC - MAGIC VALLEY/JEROME

Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
775 POLE LINE RD W
TWIN FALLS, ID
ZIP 83301
Phone: (208) 814-1000
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ST LUKE'S CLINIC LLC is a family medicine in Twin Falls, ID. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. ST LUKE'S CLINIC LLC NPI is 1790718229. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As St Lukes Clinic - Magic Valley/jerome.

The provider's business location address is:

775 POLE LINE RD W
TWIN FALLS, ID
ZIP 83301-814
Phone: (208) 814-1000

The provider's authorized official is Kathryn Fowler .
The authorized official title is Senior Vp, Cfo and has the following contact phone number (208) 381-8717.

The enumeration date for this NPI number is 7/8/2006 and was last updated on 12/8/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207R00000XInternal MedicineNo
2207RC0000XInternal MedicineCardiovascular DiseaseNo
3207RN0300XInternal MedicineNephrologyNo
4208000000XPediatricsNo
52083X0100XPreventive MedicineOccupational MedicineNo
6208600000XSurgeryNo
7261QR1300XClinic/CenterRural HealthNo
8207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1806593000MEDICAIDIDAHO
21257846OTHERIDAHOMEDICARE - CLINIC
3133992OTHERIDAHOMEDICARE - RHC
4DA1879OTHERIDAHORR MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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