ST LUKES CLINIC-TREASURE VALLEY LLC NPI 1417297821

NPI Information

NPI: 1417297821
Provider Name: ST LUKES CLINIC-TREASURE VALLEY LLC

Doing Business As: ST LUKES RHC - TRINITY MOUNTAIN

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
465 MCKENNA DR
MOUNTAIN HOME, ID
ZIP 83647
Phone: (208) 587-9703
Get Directions

ST LUKES CLINIC-TREASURE VALLEY LLC is a rural health clinic center in Mountain Home, ID. ST LUKES CLINIC-TREASURE VALLEY LLC NPI is 1417297821. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As St Lukes Rhc - Trinity Mountain.

The provider's business location address is:

465 MCKENNA DR
MOUNTAIN HOME, ID
ZIP 83647-143
Phone: (208) 587-9703

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 CLIA number assigned to this NPI record is 13D0922939 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 2/21/2013 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 Code	Taxonomy Clasification	Taxonomy Specialization	License State	Primary
1	207Q00000X	Family Medicine		IDAHO	No
2	207R00000X	Internal Medicine		IDAHO	No
3	208000000X	Pediatrics		IDAHO	No
4	261QR1300X	Clinic/Center	Rural Health	IDAHO	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1369110	OTHER	IDAHO	MEDICARE / MULTI SPECIALTY CLINIC
2	133999	OTHER	IDAHO	MEDICARE / RHC

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: 5/5/2024

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