NPIMap

Organization Active NPI

St Lukes Regional Med Ctr Dba St Lukes Pediatric Surgery of Idaho

  • Pediatric Surgery Physician
  • Boise, ID
National Provider Identifier
1720204738
Registry record updated Apr 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
Legal business name
ST LUKES REGIONAL MED CTR DBA ST LUKES PEDIATRIC SURGERY OF IDAHO
Practice address
100 E Idaho St
Suite 300
Boise, ID 83712-6223
Phone
(208) 345-5400
Fax
(208) 345-5454
NPI assigned
Apr 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2008

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

Authorized official

Name
Ms. Carrie L Cowgill
Title
Credentialing Coordinator
Phone
(208) 381-4137

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0120X Primary

Addresses

Primary practice location

100 E Idaho St
Suite 300
Boise, ID 83712-6223

Mailing address

100 E Idaho St
Suite 300
Boise, ID 83712-6223
Phone (208) 345-5400

National Provider Directory

National Provider Directory

Locations

100 E Idaho St
Ste 300
Boise, ID 83712
Phone (208) 345-5400

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207699200000",
    "number": "1720204738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E IDAHO ST",
            "address_2": "SUITE 300",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126223",
            "telephone_number": "208-345-5400",
            "fax_number": "208-345-5454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E IDAHO ST",
            "address_2": "SUITE 300",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126223",
            "telephone_number": "208-345-5400",
            "fax_number": "208-345-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKES REGIONAL MED CTR DBA ST LUKES PEDIATRIC SURGERY OF IDAHO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2008-04-09",
        "status": "A",
        "authorized_official_last_name": "COWGILL",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "208-381-4137",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Pediatric Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Apr 9, 2008; 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.