NPIMap

Organization Active NPI

St Luke's Regional Medical Center

Doing business as St Luke's Clinic - Idaho Pediatric Gastroenterology

  • Pediatric Gastroenterology Physician
  • Boise, ID
National Provider Identifier
1801197082
Registry record updated Nov 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
03 Issued in ID
Legal business name
ST LUKE'S REGIONAL MEDICAL CENTER
Doing business as
St Luke's Clinic - Idaho Pediatric Gastroenterology
Practice address
100 E Idaho St
Ste 316
Boise, ID 83712-6267
Phone
(208) 381-7310
NPI assigned
Nov 4, 2010
Last updated
Nov 4, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
ST LUKE'S REGIONAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 4, 2010

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

Authorized official

Name
Jeff Taylor
Title
System VP Cfo
Phone
(208) 381-2520

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X 03 ID Primary

Addresses

Primary practice location

100 E Idaho St
Ste 316
Boise, ID 83712-6267

Mailing address

100 E Idaho St
Ste 316
Boise, ID 83712-6267
Phone (208) 381-7310

Other names 1

  • ST LUKE'S CLINIC - IDAHO PEDIATRIC GASTROENTEROLOGY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ted Thurman FNP50 organizations share this tax ID, including this one
Part of
Ted Thurman FNP

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": "1288828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288828800000",
    "number": "1801197082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E IDAHO ST",
            "address_2": "STE 316",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126267",
            "telephone_number": "208-381-7310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E IDAHO ST",
            "address_2": "STE 316",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126267",
            "telephone_number": "208-381-7310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKE'S REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST LUKE'S REGIONAL MEDICAL CENTER",
        "enumeration_date": "2010-11-04",
        "last_updated": "2010-11-04",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "SYSTEM VP CFO",
        "authorized_official_telephone_number": "208-381-2520"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "ID",
            "license": "03",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST LUKE'S CLINIC - IDAHO PEDIATRIC GASTROENTEROLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 4, 2010; 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.