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ST LUKE'S REGIONAL MEDICAL CENTER NPI 1780793596


NPI Information

NPI: 1780793596
Provider Name: ST LUKE'S REGIONAL MEDICAL CENTER

Doing Business As: ST LUKES MOUNTAIN STATES UROLOGY

Classification: Urology - 208800000X
Entity Type: Organization

CLIA Number: 13D2013216

Address:
520 S EAGLE RD
STE 3112
MERIDIAN, ID
ZIP 83642
Phone: (208) 706-5800
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ST LUKE'S REGIONAL MEDICAL CENTER is an urology in Meridian, ID. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. ST LUKE'S REGIONAL MEDICAL CENTER NPI is 1780793596. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As St Lukes Mountain States Urology.

The provider's business location address is:

520 S EAGLE RD
STE 3112
MERIDIAN, ID
ZIP 83642-351
Phone: (208) 706-5800

The provider's authorized official is Jeff Taylor .
The authorized official title is Sr Vp/cfo and has the following contact phone number (208) 381-2520.

The CLIA number assigned to this NPI record is 13D2013216 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 8/29/2006 and was last updated on 9/30/2016.


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
12088F0040XUrologyFemale Pelvic Medicine and Reconstructive Surgery03IDAHONo
22088P0231XUrologyPediatric Urology03IDAHONo
3208800000XUrology03IDAHOYes

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
11250908MEDICARE PINIDAHO

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: 11/14/2023

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