NPIMap

Organization Active NPI

St Lukes Regional Medical Center

  • Diabetes Educator Registered Nurse
  • Boise, ID
National Provider Identifier
1003295452
Registry record updated Jun 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diabetes Educator Registered NurseTaxonomy code 163WD0400X
License
03 Issued in ID
Legal business name
ST LUKES REGIONAL MEDICAL CENTER
Practice address
1226 W River St
Boise, ID 83702-7049
Phone
(208) 331-1155
NPI assigned
May 19, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeff Taylor
Title
Sr Vice President and Cfo
Phone
(208) 381-2520

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X 03 ID
Diabetes Educator Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WD0400X 03 ID Primary

Addresses

Primary practice location

1226 W River St
Boise, ID 83702-7049

Mailing address

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2222

Other identifiers 1

IdentifierTypeStateIssuer
1003295452MedicaidID

Other names 1

  • St Luke's Humphreys Diabetes Center Doing business as

National Provider Directory

National Provider Directory

Locations

890 N 6th E
Mt Home, ID 83647
Phone (208) 376-3591

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466553600000",
    "number": "1003295452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-381-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1226 W RIVER ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027049",
            "telephone_number": "208-331-1155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKES REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-19",
        "last_updated": "2016-06-22",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "SR VICE PRESIDENT AND CFO",
        "authorized_official_telephone_number": "208-381-2520"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": "ID",
            "license": "03",
            "primary": false
        },
        {
            "code": "163WD0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "ID",
            "license": "03",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003295452",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Luke's Humphreys Diabetes Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.