St Luke's Medical Center Wood River LTD

Primary specialty

Critical Access HospitalTaxonomy code 282NC0060X

License

62 Issued in ID

Legal business name

ST LUKE'S MEDICAL CENTER WOOD RIVER LTD

Doing business as

St Lukes Clinic Woodriver - Anesthesia

Practice address

100 Hospital Drive
Ketchum, ID 83340

Phone

(208) 788-2222

NPI assigned

Feb 6, 2009

Last updated

Aug 17, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeff Taylor

Title

Senior VP Finance, Cfo

Phone

(208) 381-2520

Specialties & licenses 1

Addresses

Other names 1

• ST LUKES CLINIC WOODRIVER - ANESTHESIA Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265671739. Details of each certification follow.

• CCN 130064 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 130064

Legal name

ST LUKE'S MEDICAL CENTER - WOOD RIVER

Certification status

Terminated Voluntary: merger or closure, Aug 16, 2003

Provider type (POS)

Hospital – Short-term

Participating since

Nov 21, 2000

Last certification

Nov 21, 2000

Beds

32

Ownership / control type

Private (for profit)

Facility address

100 Hospital Drive, P O Box 100
Ketchum, ID 83340

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1233878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471392000000",
    "number": "1265671739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2777",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837012777",
            "telephone_number": "208-381-2222"
        },
        {
            "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 LUKE'S MEDICAL CENTER WOOD RIVER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-06",
        "last_updated": "2016-08-17",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "SENIOR VP FINANCE, CFO",
        "authorized_official_telephone_number": "208-381-2520"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "ID",
            "license": "62",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST LUKES CLINIC WOODRIVER - ANESTHESIA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rene Thomas Smey, OTR/L
• Ali Smith, LCPC
• Deboarh Snider, CCH
• Joann Sorento, PH.D.
• Wayne Julian Spector, D.M.D.
• St Lukes Clinic - Wood River LLC
• St Lukes Medical Center Woodriver (St Lukes Clinic Woodriver)
• St Lukes Medical Center Woodriver LTD
• St Lukes Medical Center Woodriver LTD (St Lukes Woodriver Internal Medicine)
• St Lukes Wood River Medical Center LTD (St Lukes Woodriver Swingbeds)

• Critical Access Hospital in Ketchum, ID
• Providers in Ketchum, ID by specialty
• Critical Access Hospital in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.