NPIMap

Organization Active NPI

St Lukes Medical Center Woodriver LTD

  • Home Health Agency
  • Ketchum, ID
National Provider Identifier
1093844367
Registry record updated Dec 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
62 Issued in ID
Legal business name
ST LUKES MEDICAL CENTER WOODRIVER LTD
Practice address
100 Hospital Drive
Ketchum, ID 83340
Phone
(208) 788-2222
NPI assigned
Mar 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2007

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

Authorized official

Name
Bruce Jensen
Title
Director
Phone
(208) 788-2222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 62 ID Primary

Addresses

Primary practice location

100 Hospital Drive
Ketchum, ID 83340

Mailing address

PO Box 1098
Boise, ID 83701-1098
Phone (208) 381-2333

Other identifiers 1

IdentifierTypeStateIssuer
62OtherIDSTATE LIC #

Other names 1

  • SLWR HOSPICE HOMECARE Other name

National Provider Directory

National Provider Directory
Tax ID family
St Lukes Medical Center Woo4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196812800000",
    "number": "1093844367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1098",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837011098",
            "telephone_number": "208-381-2333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL DRIVE",
            "city": "KETCHUM",
            "state": "ID",
            "postal_code": "83340",
            "telephone_number": "208-788-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKES MEDICAL CENTER WOODRIVER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2007-12-05",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "208-788-2222"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "ID",
            "license": "62",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LIC #",
            "identifier": "62",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SLWR HOSPICE HOMECARE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ketchum, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2007; 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.