ST LUKE'S MAGIC VALLEY REGIONAL MEDICAL CENTER LTD (NPI# 1366874877) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366874877 |
| Entity Type | Organization |
| Organization Name | ST LUKE'S MAGIC VALLEY REGIONAL MEDICAL CENTER LTD |
| Other Organization Name | ST LUKE'S JEROME |
| Practice Address |
709 N Lincoln Ave Jerome ID 83338-1851 |
| Mailing Address |
Po Box 2777 Boise ID 83701-2777 |
| Practice Telephone | 2083244301 |
| Mailing Telephone | 2083244301 |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2018-11-28 |
| Authorized Official Name | JEFF TAYLOR (SENIOR VP FINANCE, CFO) |
| Authorized Official Telephone | 2083812520 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282NC0060X |
General Acute Care Hospital Specialization: Critical Access |
08 | ID | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | BLUE SHIELD OF IDAHO | 000010006683 | 01 |
| ID | TRICARE | 0000 | 01 |
| ID | 002287000 | 05 | |
| ID | BLUE CROSS OF IDAHO | 00265 | 01 |
| Other Name | Type Code |
|---|---|
| ST LUKE'S JEROME | Doing Business As Name - Organization |
| Street Address |
709 N LINCOLN AVE |
| City | JEROME |
| State | ID |
| Zip Code | 83338-1851 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336138783 | Brian Lee Johnson | Family Medicine | 709 N Lincoln Ave, Jerome, ID 83338-1851 | 2005-10-18 |
| 1609414051 | Troy M Jackman | Pharmacist | 709 N Lincoln Ave, Jerome, ID 83338-1851 | 2019-12-17 |
| 1891165569 | Anne B Fullmer | Nurse Practitioner | 709 N Lincoln Ave, Jerome, ID 83338-1851 | 2015-10-06 |
| 1730511254 | St Lukes Magic Valley Regional Medical Center Ltd | Medicare Defined Swing Bed Unit | 709 N Lincoln Ave, Jerome, ID 83338-1851 | 2013-08-07 |
| 1912137175 | Paul A Dickinson | Nurse Anesthetist, Certified Registered | 709 N Lincoln Ave, Jerome, ID 83338-1851 | 2009-07-22 |
| 1700053774 | St Benedicts Fmc Physician Assistants | Physician Assistant | 709 N Lincoln Ave, Jerome, ID 83338-1851 | 2008-05-09 |
| 1083833933 | Thomas Henry Zepeda | Personal Emergency Response Attendant | 709 N Lincoln Ave, Jerome, ID 83338-1851 | 2007-04-25 |
| 1639211634 | St. Benedicts Family Medical Center | Long Term Care Hospital | 709 N Lincoln Ave, Jerome, ID 83338-1851 | 2007-02-13 |
| 1750489647 | Richard Emery Lally | Emergency Medicine | 709 N Lincoln Ave, Jerome, ID 83338-1851 | 2006-09-21 |
| 1902856727 | St Benedicts Family Medical Center | Skilled Nursing Facility | 709 N Lincoln Ave, Jerome, ID 83338-1851 | 2006-05-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295336709 | Family Health Services Pharmacy | Pharmacy | 218 W. Nez Perce, Jerome, ID 83338 | 2020-11-03 |
| 1811391626 | Summit Therapy Services | In Home Supportive Care | 113 East Ave. F, Jerome, ID 83338 | 2014-10-22 |
| 1952645285 | Readings Community Pharmacy Inc | Pharmacy | 133 West A, Jerome, ID 83338 | 2012-11-27 |
| 1801121298 | Yolanda S. Sedano | Physician Assistant | 132 5th Ave West, Jerome, ID 83338 | 2009-10-02 |
| 1295898310 | Ronald Gail Hendrickson | Dentist | 128 South Adams, Jerome, ID 83338 | 2006-12-19 |
| 1316035512 | Johnson Chiropractic Clinic | Chiropractor | 600 N Lincoln Ave, Jerome, ID 83338 | 2006-10-11 |
| 1265527725 | Lon M. Egbert, P.C. | Specialist/Technologist | 128 5th Ave West, Jerome, ID 83338 | 2006-10-03 |
| 1992898605 | St Benedicts Family Medical Center | Home Health | 414 N Lincoln, Suite 1, Jerome, ID 83338 | 2006-10-02 |
| 1790231355 | Lexa Marie Balling | Pharmacist | 2680 S Lincoln Ave, Jerome, ID 83338 | 2016-09-01 |
| 1922037530 | St Benedicts Family Medical Center | Clinic/Center | 115 5th Ave W, Jerome, ID 83338-1824 | 2006-07-03 |
| Find all providers in zip 83338 | ||||
| Taxonomy Code | 282NC0060X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| Specialization | Critical Access |
| Definition to come. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851761464 | Brent Leavitt | General Acute Care Hospital | 4928 Pleasant View Dr, Chubbuck, ID 83202-1640 | 2015-09-25 |
| 1053669598 | Teton Valley Health Care, Inc | General Acute Care Hospital | 120 E Howard Avenue, Driggs, ID 83422-5112 | 2012-08-15 |
| 1639406267 | Florence Hospital, LLC | General Acute Care Hospital | 1300 E State St, Suite 102, Eagle, ID 83616-7059 | 2009-11-03 |
| 1912132176 | Initiatives Healthcare, LLC | General Acute Care Hospital | 1205 N 11th St, Boise, ID 83702-4102 | 2009-05-18 |
| 1417122821 | Elmore Medical Center Specialty Physician Group | General Acute Care Hospital | 890 N 6th E, Mountain Home, ID 83647-2206 | 2008-04-25 |
| 1275703241 | North Canyon Medical Center, Inc. | General Acute Care Hospital | 267 North Canyon Drive, Gooding, ID 83330-1858 | 2008-03-06 |
| 1720298102 | Weiser Valley Hospital District | General Acute Care Hospital | 645 E. 5th Street, Weiser, ID 83672-2202 | 2007-05-23 |
| 1548320435 | Benewah Community Hospital | General Acute Care Hospital | 229 South 7th St, St Maries, ID 83861 | 2006-12-11 |
| 1295769537 | Gooding County Hospital District | General Acute Care Hospital | 1120 Montana St, Gooding, ID 83330-1858 | 2006-07-11 |
| 1881641629 | Weiser Valley Hospital District | General Acute Care Hospital | 645 E. 5th St., Weiser, ID 83672-2202 | 2006-05-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.