NPIMap

Organization Active NPI

St Lukes Medical Center Woodriver LTD

Doing business as St Lukes Woodriver Internal Medicine

  • Internal Medicine Physician
  • Ketchum, ID
National Provider Identifier
1841343720
Registry record updated Aug 22, 2020
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 LTD
Doing business as
St Lukes Woodriver Internal Medicine
Practice address
100 Hospital Drive
Ketchum, ID 83340
Phone
(208) 788-2222
NPI assigned
Jan 22, 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
Bruce Jensen
Title
Director
Phone
(208) 727-8401

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 62 ID Primary

Addresses

Primary practice location

100 Hospital Drive
Ketchum, ID 83340

Mailing address

PO Box 1098
Boise, ID 83701-1098
Phone (208) 381-2222

Other identifiers 1

IdentifierTypeStateIssuer
62OtherIDHOSPITAL STATE LICENSE #

Other names 1

  • ST LUKES WOODRIVER INTERNAL MEDICINE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Lukes Medical Ctr Wo4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1841343720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1098",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837011098",
            "telephone_number": "208-381-2222"
        },
        {
            "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 LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "208-727-8401"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "62",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOSPITAL STATE LICENSE #",
            "identifier": "62",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST LUKES WOODRIVER INTERNAL MEDICINE",
            "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 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.