ST LUKES CLINIC - TREASURE VALLEY LLC (NPI# 1861982456) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861982456 |
| Entity Type | Organization |
| Organization Name | ST LUKES CLINIC - TREASURE VALLEY LLC |
| Other Organization Name | ST LUKE'S LIFESTYLES MEDICINE |
| Practice Address |
5155 S Howry Lane Meridian ID 83642 |
| Mailing Address |
190 E Bannock St Boise ID 83712-6241 |
| Practice Telephone | 2083812222 |
| Mailing Telephone | 2083812222 |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2018-05-18 |
| Authorized Official Name | JEFF TAYLOR (SR VP & CFO) |
| Authorized Official Telephone | 2083812520 |
| Is Organization Subpart | Y |
| Parent Organization Name | ST. LUKE'S HEALTH SYSTEM |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2083P0901X |
Preventive Medicine Specialization: Public Health & General Preventive Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| St Luke's Lifestyles Medicine | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871835538 | St Lukes Clinic - Treasure Valley LLC | Durable Medical Equipment & Medical Supplies | 3950 17th St, Baker City, OR 97814-1300 | 2013-03-20 |
| 1326336058 | St Lukes Clinic - Treasure Valley LLC | Emergency Medicine | 190 E Bannock St, Boise, ID 83712-6241 | 2011-07-15 |
| Street Address |
5155 S HOWRY LANE |
| City | MERIDIAN |
| State | ID |
| Zip Code | 83642 |
| 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 | 2083P0901X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Public Health & General Preventive Medicine |
| Public health and general preventive medicine focuses on promoting health, preventing disease, and managing the health of communities and defined populations. These practitioners combine population-based public health skills with knowledge of primary, secondary, and tertiary prevention-oriented clinical practice in a wide variety of settings. |
| 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 Preventive Medicine, 2007. http://www.abprevmed.org/. American Osteopathic Board of Preventive Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Preventive Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528221140 | Fritz Roland Dixon | Preventive Medicine | 968 E Dominica Dr, Meridian, ID 83642-6668 | 2008-07-03 |
| 1043309222 | Rebecca James | Preventive Medicine | 3128 8th St, Meridian, MS 39301-4753 | 2006-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114235025 | Susan French | Preventive Medicine | 304 Copper Bay Road, Nordman, ID 83848 | 2010-09-14 |
| 1811180946 | April Charlene Dawson | Preventive Medicine | 13400 South Pleasant Valley Road, Idaho Maximum Security Institution, Kuna, ID 83634 | 2007-08-22 |
| 1184845976 | Charles Elwood Reed | Preventive Medicine | 924 E Ash St, Caldwell, ID 83605-5321 | 2007-05-01 |
| 1215366406 | Passport Health Holdings, LLC | Preventive Medicine | 910 Main Street, Suite 352, Boise, ID 83702-5743 | 2013-11-07 |
| 1194761460 | Jacob Kammer | Preventive Medicine | 6533 W Emerald St, Boise, ID 83704-8737 | 2006-06-22 |
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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.