Organization Name: | ST LUKES MCCALL LTD |
NPI Number: | 1245503614 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JEFF TAYLOR (SYSTEM VP CFO) |
Mailing Address: | 211 Forest St Mccall |
State: | ID US |
Postal Code: | 836385256 |
Phone Number: | 2086342225 |
Fax Number: | |
NPI Enumeration Date: | 02/16/2012 |
NPI Last Update Date: | 02/16/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207QA0000X |
License Number: | 11 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | ID |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Family Medicine |
Taxonomy Specialization: | Adolescent Medicine |
Taxonomy Definition: | A family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs. |