Organization Name: | ST LUKES MAGIC VALLEY REGIONAL MEDICAL CENTER LTD |
NPI Number: | 1326470840 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES ANGLE (CEO) |
Mailing Address: | 132 5th Ave W Jerome |
State: | ID US |
Postal Code: | 833381825 |
Phone Number: | 2083245286 |
Fax Number: | |
NPI Enumeration Date: | 08/07/2013 |
NPI Last Update Date: | 03/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |