St Lukes Idaho Cardiology Associates
Organization Active NPI Cardiovascular Disease Physician · Nampa, ID
NPI 1306137633 · NPPES record last updated Apr 20, 2011
Key facts
- NPI
- 1306137633
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- License
- 140728 (OR)
- Legal business name
- ST LUKES IDAHO CARDIOLOGY ASSOCIATES
- Practice address
- 215 E Hawaii Ave
Nampa, ID 83686-6011 - Phone
- (208) 322-1680
- NPI assigned
- Apr 20, 2011
- Organization subpart
- Yes
- Parent organization (as reported)
- GRANDE RONDE HOSPITAL, INC
Authorized official
- Name
- Mr. James A Mattes
- Title
- President/Ceo
- Phone
- (541) 963-1454
Corporate family (same tax ID) 10
National Provider Directory
- Tax ID family
- Robert Fuller MD
- Part of
- Robert Fuller MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician |
207RC0000X | 140728 | OR | Yes |
Addresses
Primary practice location
215 E Hawaii Ave
Nampa, ID 83686-6011
Mailing address
900 Sunset Dr
PO Box 3290
La Grande, OR 97850-1362
Phone (541) 963-1555
Other providers in Nampa, ID
- Ryan T Speirs
- Spero Mental Health LLC
- Jessica Sproul I
- Emily Rachael Spurlock
- Todd Squires
- St Lukes Regional Medical Center
- St Lukes Regional Medical Center
- St Lukes Regional Medical Center
- St Lukes Regional Medical Center
- St Lukes Regional Medical Center
All providers in Nampa, ID · Cardiovascular Disease Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.