St Lukes Clinic - Treasure Valley LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

03 Issued in ID

Legal business name

ST LUKES CLINIC - TREASURE VALLEY LLC

Doing business as

St Lukes EOMA DME

Practice address

3950 17TH St
Baker City, OR 97814-1300

Phone

(541) 523-1001

NPI assigned

Mar 20, 2013

Organization subpart

Yes

Parent organization

ST LUKES REGIONAL MEDICAL CENTERAs reported in NPPES

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

Authorized official

Name

Jeffrey Taylor

Title

Cfo

Phone

(208) 381-2520

Specialties & licenses 1

Addresses

Other names 1

• St Lukes EOMA DME Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• St Lukes Clinic-Treasure Valley LLC

  • Rural Health Clinic/Center
  • Baker City, OR
  • NPI 1336442607

  O20120420000013

  Same enrollment
• St Lukes Clinic-Treasure Valley LLC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1326336058

  O20120420000013

  Same enrollment

Part of

Richard H Lane MD

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• St Lukes Regional Medical Center

  • Pharmacy
  • Boise, ID
  • NPI 1649332768

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1363737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363737600000",
    "number": "1871835538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-381-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 17TH ST",
            "city": "BAKER CITY",
            "state": "OR",
            "postal_code": "978141300",
            "telephone_number": "541-523-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKES CLINIC - TREASURE VALLEY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST LUKES REGIONAL MEDICAL CENTER",
        "enumeration_date": "2013-03-20",
        "last_updated": "2013-03-20",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "208-381-2520"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "ID",
            "license": "03",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Lukes EOMA DME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• J Daniel Smithson, MD
• Scarlett Mary Soto, LMT
• Paula Southwick
• Eleanor G Spangler, BS
• Frank Spear
• St Lukes Clinic-Treasure Valley LLC
• St. Elizabeth Health Services, Inc.
• Flint Anthony Stearns, OTRL ATP CWCE
• Tyrah Robian Steele
• Mitchell Paul Stephens

• Durable Medical Equipment & Medical Supplies in Baker City, OR
• Providers in Baker City, OR by specialty
• Durable Medical Equipment & Medical Supplies in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.