Provider Type Icon

ST LUKE'S HUMPHREYS DIABETES CENTER INC NPI 1306984729


NPI Information

NPI: 1306984729
Provider Name: ST LUKE'S HUMPHREYS DIABETES CENTER INC

Former Legal Business Name: HUMPHREYS DIABETES CENTER INC

Classification: Dietitian, Registered - 133V00000X
Entity Type: Organization

CLIA Number: 13D2212300

Address:
1226 W RIVER ST
BOISE, ID
ZIP 83702
Phone: (208) 331-1155
Get Directions

ST LUKE'S HUMPHREYS DIABETES CENTER INC is a dietitian registered in Boise, ID. The provider is a Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation. ST LUKE'S HUMPHREYS DIABETES CENTER INC NPI is 1306984729. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Humphreys Diabetes Center Inc.

The provider's business location address is:

1226 W RIVER ST
BOISE, ID
ZIP 83702-049
Phone: (208) 331-1155
Fax: (208) 383-0190

The provider's authorized official is Robert Scanlon .
The authorized official title is Executive Director and has the following contact phone number (208) 331-1155.

The CLIA number assigned to this NPI record is 13D2212300 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/1/2007 and was last updated on 7/28/2011.


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
1332B00000XDurable Medical Equipment & Medical Supplies4366980001IDAHONo
2133V00000XDietitian, RegisteredYes

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
11920300MEDICARE PINIDAHO
2000010013347OTHERIDAHOBLUE SHIELD
38G502OTHERIDAHOBLUE CROSS
4D33630MEDICARE UPINIDAHO
5807850000MEDICAIDIDAHO
6806348400MEDICAIDIDAHO
7000010170136OTHERIDAHOREGENCE WALTERS
84366980001MEDICARE NSCIDAHO

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.