St Lukes Regional Medical Center DBA St Luke's Internal Medicine

NPI #1790983385 in Boise, Idaho

Provider Information

NPI Number: 1790983385
Entity Type: Organization
Organization Name: St Lukes Regional Medical Center DBA St Luke's Internal Medicine
Primary Specialty: Physician Assistant
Enumeration Date: Jul 5, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 300 E JEFFERSON ST
City: Boise
State: Idaho
ZIP Code: 83712-6246
Phone: (208) 381-4100

Authorized Official

Name: MS. CARRIE LYNNE COWGILL
Title: CREDENTIALING COORDINATOR
Phone: (208) 381-4137

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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