Organization Name: | ST LUKE'S MAGIC VALLEY REGIONAL MEDICAL CENTER LTD |
NPI Number: | 1366874877 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES ANGLE (PRESIDENT & CEO) |
Mailing Address: | 709 N Lincoln Ave Jerome |
State: | ID US |
Postal Code: | 833381851 |
Phone Number: | 2083244301 |
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: | 282NC0060X |
License Number: | 08 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Hospitals |
Taxonomy Classification: | General Acute Care Hospital |
Taxonomy Specialization: | Critical Access |
Taxonomy Definition: |