ST LUKES CLINIC-TREASURE VALLEY LLC (NPI# 1417297821) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417297821 |
| Entity Type | Organization |
| Organization Name | ST LUKES CLINIC-TREASURE VALLEY LLC |
| Other Organization Name | ST LUKES CLINIC - TRINITY MOUNTAIN |
| Practice Address |
465 Mckenna Dr Mountain Home ID 83647-2143 |
| Mailing Address |
Po Box 640 Boise ID 83701-0640 |
| Practice Telephone | 2085879703 |
| Mailing Telephone | 2083812222 |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2016-09-29 |
| Authorized Official Name | JEFF TAYLOR (SYSTEM VP CFO) |
| Authorized Official Telephone | 2083812520 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | ID | Allopathic & Osteopathic Physicians | |
| N | 207R00000X | Internal Medicine | ID | Allopathic & Osteopathic Physicians | |
| N | 208000000X | Pediatrics | ID | Allopathic & Osteopathic Physicians | |
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
ID | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| St Lukes Clinic - Trinity Mountain | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336442607 | St Lukes Clinic-treasure Valley LLC | Family Medicine | 3950 17th St, Baker City, OR 97814-1300 | 2010-12-08 |
| Street Address |
465 MCKENNA DR |
| City | MOUNTAIN HOME |
| State | ID |
| Zip Code | 83647-2143 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487634424 | Wayne Martin | Nurse Practitioner | 465 Mckenna Dr, Mountain Home, ID 83647-2143 | 2006-01-17 |
| 1427555119 | Jamie Knapp | Physician Assistant | 465 Mckenna Dr, Mountain Home, ID 83647-2143 | 2018-04-09 |
| 1871092189 | Joseph Wells Hoskin | Physician Assistant | 465 Mckenna Dr, Mountain Home, ID 83647-2143 | 2018-02-02 |
| 1891197570 | Emily Moore | Physician Assistant | 465 Mckenna Dr, Mountain Home, ID 83647-2143 | 2014-09-24 |
| 1265852909 | Whitney Ann Roberts | Physician Assistant | 465 Mckenna Dr, Mountain Home, ID 83647-2143 | 2014-04-21 |
| 1780752469 | Timothy James Muhonen | Family Medicine | 465 Mckenna Dr, Mountain Home, ID 83647 | 2006-12-01 |
| 1508846353 | Karl H. Olson | Family Medicine | 465 Mckenna Dr, Mountain Home, ID 83647-2143 | 2006-01-18 |
| 1831179696 | Elmore Medical Center Hospital District | Family Medicine | 465 Mckenna Dr, Mountain Home, ID 83647-2143 | 2006-01-18 |
| 1558341594 | Dennis Dan Crossley | Family Medicine | 465 Mckenna Dr, Mountain Home, ID 83647-2143 | 2006-01-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528684370 | The Unruly Tongue Myofunctional Therapy LLC | Specialist | 1125 Nw Bluegrass Cir, Mountain Home, ID 83647 | 2020-06-17 |
| 1740767284 | Kelly Loy | Counselor | 210 North 3rd East, Mountain Home, ID 83647 | 2018-07-27 |
| 1891247912 | Daelene Sueann Tibbitts | Physical Therapy Assistant | 1665 E 5th N, Mountain Home, ID 83647 | 2016-10-25 |
| 1689065765 | Emma Orthel | Counselor | 2240 American Legion Blvd, Mountain Home, ID 83647 | 2015-02-11 |
| 1073692166 | Krzysztof Hendryk Ziola | Internal Medicine | 2280 American Legion Blvd., Mountain Home, ID 83647 | 2006-11-02 |
| 1952482440 | Michael Peter Koelsch | Internal Medicine | 805 North 6th East, Mountain Home, ID 83647 | 2006-10-18 |
| 1124113709 | Talmage W Delange | Counselor | 235 North 3rd East, Mountain Home, ID 83647 | 2006-10-03 |
| 1225044019 | Scott W Sessions | Physical Therapist | 245 N. 3rd, Mountain Home, ID 83647 | 2006-07-31 |
| 1750370730 | Kyle J Kenison | Optometrist | 855 West 6th South, Mountain Home, ID 83647 | 2005-10-21 |
| 1285628156 | Bruce Joseph Siedlecki | Obstetrics & Gynecology | Mtn.home Aif Force Base, Mdos, Mtn. Home, ID 83647 | 2005-09-07 |
| Find all providers in zip 83647 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376160457 | North Canyon Jerome Clinic | Clinic/Center | 491 Heritage Dr, Jerome, ID 83338-6701 | 2020-07-06 |
| 1063970143 | Idaho Street Medical Clinic | Clinic/Center | 126 Idaho Ave., Homedale, ID 83628-8362 | 2019-03-07 |
| 1568950566 | North Canyon Medical Center, Inc. | Clinic/Center | 718 Hwy 30, Buhl, ID 83316 | 2018-04-25 |
| 1518377019 | North Canyon Medical Center, Inc. | Clinic/Center | 267 N. Canyon Drive, Gooding, ID 83330 | 2014-05-06 |
| 1700206588 | Mvh Bmc LLC | Clinic/Center | 210 S Emerson Ave, Shelley, ID 83274-1229 | 2014-04-21 |
| 1922243088 | Bmh Inc | Clinic/Center | 1355 Parkway Dr, Blackfoot, ID 83221-1656 | 2008-12-03 |
| 1023271731 | Upper Valley Family Medicine Rhc | Clinic/Center | 530 Rigby Lake Dr, Rigby, ID 83442-1271 | 2008-07-03 |
| 1891984167 | Bmh Inc | Clinic/Center | 1425 Parkway Drive, Blackfoot, ID 83221-1758 | 2007-10-23 |
| 1043387426 | Minidoka Memorial Hospital | Clinic/Center | 1308 8th St, Suite 1, Rupert, ID 83350-1530 | 2006-11-29 |
| 1356438816 | Gritman Medical Center Inc | Clinic/Center | 156 6th St, Potlatch, ID 83855 | 2006-10-06 |
| Find all providers with the same taxonomy | ||||
| City | MOUNTAIN HOME |
| Zip Code | 83647 |
Please comment or provide details below to improve the information on ST LUKES CLINIC-TREASURE VALLEY LLC.
| 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.