NPIMap

Organization Active NPI

St Lukes Regional Medical Center Dba St Luke's Internal Medicine

  • Physician Assistant
  • Boise, ID
National Provider Identifier
1790983385
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Legal business name
ST LUKES REGIONAL MEDICAL CENTER DBA ST LUKE'S INTERNAL MEDICINE
Practice address
300 E Jefferson St
Boise, ID 83712-6246
Phone
(208) 381-4100
Fax
(208) 381-4101
NPI assigned
Jul 5, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

300 E Jefferson St
Boise, ID 83712-6246

Mailing address

PO Box 550
Boise, ID 83701-0550
Phone (208) 381-4100

Other names 1

  • SLIM Midlevel Providers Other name

National Provider Directory

National Provider Directory
Tax ID family
St Lukes Regional Med Ctr50 organizations share this tax ID, including this one

Other organizations with this tax ID 49

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

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1183593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790983385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837010550",
            "telephone_number": "208-381-4100",
            "fax_number": "208-381-4101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E JEFFERSON ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126246",
            "telephone_number": "208-381-4100",
            "fax_number": "208-381-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKES REGIONAL MEDICAL CENTER DBA ST LUKE'S INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COWGILL",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_middle_name": "LYNNE",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "208-381-4137",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SLIM Midlevel Providers",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Aug 22, 2020; 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.