NPIMap

Organization Active NPI

St Lukes Regional Medical Center

Doing business as St Lukes Clinic - Capital City Family Medicine

  • Family Medicine Physician
  • Boise, ID
National Provider Identifier
1053624759
Registry record updated Jul 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
03 Issued in ID
Legal business name
ST LUKES REGIONAL MEDICAL CENTER
Doing business as
St Lukes Clinic - Capital City Family Medicine
Practice address
1520 W State St
Ste 100
Boise, ID 83702-4085
Phone
(208) 947-7700
NPI assigned
Jul 22, 2010
Last updated
Jul 22, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
ST LUKES REGIONAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 22, 2010

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

Authorized official

Name
John Kee
Title
VP Physician Services
Phone
(208) 381-5329

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 03 ID Primary
Internal Medicine Physician 207R00000X 03 ID
Pediatrics Physician 208000000X 03 ID

Addresses

Primary practice location

1520 W State St
Ste 100
Boise, ID 83702-4085

Mailing address

1520 W State St
Ste 100
Boise, ID 83702-4085
Phone (208) 947-7700

Other names 1

  • ST LUKES CLINIC - CAPITAL CITY FAMILY MEDICINE Doing business as

National Provider Directory

National Provider Directory
Part of
St Lukes Regional Med Ctr

Locations

1520 W State St
Ste 100
Boise, ID 83702
Phone (208) 947-7700

NPI Registry JSON

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

{
    "created_epoch": "1279756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279756800000",
    "number": "1053624759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 W STATE ST",
            "address_2": "STE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024085",
            "telephone_number": "208-947-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 W STATE ST",
            "address_2": "STE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024085",
            "telephone_number": "208-947-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKES REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST LUKES REGIONAL MEDICAL CENTER",
        "enumeration_date": "2010-07-22",
        "last_updated": "2010-07-22",
        "status": "A",
        "authorized_official_last_name": "KEE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "VP PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "208-381-5329"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "03",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "03",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ID",
            "license": "03",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST LUKES CLINIC - CAPITAL CITY FAMILY MEDICINE",
            "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 Jul 22, 2010; 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.