ST LUKES REGIONAL MEDICAL CENTER (NPI# 1568731925) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568731925 |
| Entity Type | Organization |
| Organization Name | ST LUKES REGIONAL MEDICAL CENTER |
| Other Organization Name | ST LUKES CLINIC - GENERAL SURGERY |
| Practice Address |
3399 E Louise Dr Ste 400 Meridian ID 83642-5047 |
| Mailing Address |
190 E Bannock St Boise ID 83712-6241 |
| Practice Telephone | 2083643000 |
| Practice Fax Number | 2083643191 |
| Mailing Telephone | 2083812222 |
| Enumeration Date | 2011-12-14 |
| Last Update Date | 2011-12-14 |
| Authorized Official Name | JEFF TAYLOR (SYSTEM VP CFO) |
| Authorized Official Telephone | 2083812520 |
| Authorized Official Credential | CFO |
| Is Organization Subpart | Y |
| Parent Organization Name | ST LUKES REGIONAL MEDICAL CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 03 | ID | Allopathic & Osteopathic Physicians |
| Y | 208600000X | Surgery | 03 | ID | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| ST LUKES CLINIC - GENERAL SURGERY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639356173 | St Lukes Regional Medical Center | Family Medicine | 11311 W Chinden Blvd, Boise, ID 83714-1021 | 2008-01-28 |
| 1023201084 | St Lukes Regional Medical Center | Clinic/Center | 100 E Idaho St Ste 200, Boise, ID 83712-6270 | 2007-08-23 |
| 1770586794 | St Lukes Regional Medical Center | Pharmacy | 190 E Bannock St, Boise, ID 83712-6241 | 2005-05-23 |
| 1003295452 | St Lukes Regional Medical Center | Dietitian, Registered | 1226 W River St, Boise, ID 83702-7049 | 2015-05-19 |
| 1093109100 | St Lukes Regional Medical Center | Clinical Medical Laboratory | 3176 S Denver Way, Boise, ID 83705-5289 | 2015-03-26 |
| 1477954204 | St Lukes Regional Medical Center | Ambulance | 895 N 6th E, Mountain Home, ID 83647-2207 | 2014-09-11 |
| 1730505199 | St Lukes Regional Medical Center | Rehabilitation Unit | 600 N Robbins Rd, Boise, ID 83702-4565 | 2014-03-10 |
| 1093131450 | St Lukes Regional Medical Center | Skilled Nursing Facility | 600 N Robbins Rd, Boise, ID 83702-4565 | 2014-03-10 |
| 1326388737 | St Lukes Regional Medical Center | Surgery | 895 N 6th E, Mountain Home, ID 83647-2207 | 2013-02-21 |
| 1710226451 | St Lukes Regional Medical Center | Medicare Defined Swing Bed Unit | 895 N 6th E, Mountain Home, ID 83647-2207 | 2013-01-31 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | ST LUKES REGIONAL MEDICAL CENTER SIOUX CITY | 2720 Stone Park Blvd, Sioux City, IA 51104-3734 |
| Street Address |
3399 E LOUISE DR STE 400 |
| City | MERIDIAN |
| State | ID |
| Zip Code | 83642-5047 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740231620 | Roberto V. Barresi | Surgery | 3399 E Louise Dr, Ste 400, Meridian, ID 83642-5047 | 2006-05-15 |
| 1235761818 | Jessa Cook | Specialist/Technologist | 3399 E Louise Dr, Meridian, ID 83642-5211 | 2020-02-11 |
| 1245789536 | Lauren Galligar | Physician Assistant | 3399 E Louise Dr, Meridian, ID 83642-5047 | 2016-09-27 |
| 1841615754 | Kelly Carman | Surgery | 3399 E Louise Dr, Meridian, ID 83642-5211 | 2014-02-28 |
| 1447688312 | Anne M Peterson | Physician Assistant | 3399 E Louise Dr, Ste 400, Meridian, ID 83642-5047 | 2013-10-31 |
| 1902188147 | Wendy M. Jones | Physician Assistant | 3399 E Louise Dr, Suite 400, Meridian, ID 83642-5047 | 2011-09-14 |
| 1457382723 | Jonathan V. Giles | Surgery | 3399 E Louise Dr, Suite 400, Meridian, ID 83642-5047 | 2006-07-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174145684 | Ikdo South Meridian LLC | Dentist | 3839 E Amity Rd, Meridian, ID 83642 | 2020-05-07 |
| 1073133328 | Prescription Pad LLC | Pharmacy | 885 S Vanguard Way, Meridian, ID 83642 | 2020-04-16 |
| 1609412683 | Meridian Advanced Psychiatry, LLC | Psychiatry & Neurology | 1672 S Woodsage Ave., Meridan, ID 83642 | 2019-11-25 |
| 1194378927 | Sergey Tsema | Occupational Therapist | 1259 E Pisa St, Meridian, ID 83642 | 2019-07-21 |
| 1003478629 | Chris R Jackson | Dentist | Isu Family Dentistry, 1311 E Central Dr, Meridian, ID 83642 | 2019-07-03 |
| 1285293118 | Morgan Family Medicine | Nurse Practitioner | 1660 S Woodsage Avenue, Meridian, ID 83642 | 2019-06-13 |
| 1033772793 | Nugen Healthcare, Pllc | Registered Nurse | 2177 S Spoonbill Ave, Meridian, ID 83642 | 2019-04-18 |
| 1811471790 | Courtney Crossland | Physician Assistant | 4949 S Hillsdale Ave., Meridian, ID 83642 | 2018-09-18 |
| 1841771938 | Katelyn Perry | Counselor | 2068 S. Eagle Rd., Meridian, ID 83642 | 2018-08-27 |
| 1114406204 | Gem Prep: Meridian LLC | Case Management | 2750 E.gala Ct., Meridian, ID 83642 | 2018-08-09 |
| Find all providers in zip 83642 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508350331 | Matthew Jacobsson | Surgery | 2920 N High Desert Way, Meridian, ID 83646-9066 | 2018-06-15 |
| 1881794162 | James Howard Wallace | Surgery | 1600 22nd Ave Fl 3, Meridian, MS 39301 | 2006-09-25 |
| 1184652364 | David J Brown | Surgery | 3875 E Overland Rd Ste 1c, Meridian, ID 83642-9005 | 2006-06-28 |
| 1023060258 | Scott A. Henson | Surgery | 3399 E. Louise Dr., #400, Meridian, ID 83642 | 2006-05-16 |
| 1740231620 | Roberto V. Barresi | Surgery | 3399 E Louise Dr, Ste 400, Meridian, ID 83642-5047 | 2006-05-15 |
| 1700866290 | Jay M. Crutchfield | Surgery | 1401 E Central Dr, Meridian, ID 83642-8046 | 2006-01-19 |
| 1477014207 | Idaho Bariatric and Metabolic Institute L.L.C. | Surgery | 3875 E Overland Rd Ste 1c, Meridian, ID 83642-9005 | 2019-03-26 |
| 1689119851 | Medical Arts Surgical Group | Surgery | 1800 12th St, Meridian, MS 39301-4158 | 2016-12-27 |
| 1295145118 | Matthew Coker | Surgery | 2111 14th St, Meridian, MS 39301-4041 | 2014-04-30 |
| 1518382472 | Jason Defatta | Surgery | 1800 12th St, Meridian, MS 39301-4158 | 2014-02-28 |
| Find all providers in MERIDIAN | ||||
Please comment or provide details below to improve the information on ST LUKES REGIONAL MEDICAL CENTER.
| 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.