NPIMap

Organization Active NPI

St Lukes Medical Center Woodriver

  • Internal Medicine Physician
  • Ketchum, ID
National Provider Identifier
1629255153
Registry record updated Jun 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
62 Issued in ID
Legal business name
ST LUKES MEDICAL CENTER WOODRIVER
Practice address
100 Hospital Drive
Ketchum, ID 83340
Phone
(208) 788-2222
NPI assigned
Jan 28, 2008
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
Cfo, VP Finance
Phone
(208) 381-2520

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X 62 ID
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 62 ID Primary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X 62 ID

Addresses

Primary practice location

100 Hospital Drive
Ketchum, ID 83340

Mailing address

PO Box 640
Boise, ID 83701-0640

Other names 1

  • ST LUKES CLINIC WOODRIVER Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1201478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466553600000",
    "number": "1629255153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 640",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837010640"
        },
        {
            "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",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-28",
        "last_updated": "2016-06-22",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CFO, VP FINANCE",
        "authorized_official_telephone_number": "208-381-2520"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": "ID",
            "license": "62",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "62",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "ID",
            "license": "62",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST LUKES CLINIC WOODRIVER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 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.