Organization · Type 2 NPI

ST Luke's Regional Medical Center

Pediatric Neurodevelopmental Disabilities Physician · Boise, ID

NPI number 1316243330 Active

Practice location

100 E Idaho St, Ste 200
Boise, ID 83712-6267

Call (208) 381-5000 Map

Fax (208) 381-5005

Mailing address

190 E Bannock St
Boise, ID 83712-6241

Specialties and licenses

Taxonomy	Code	License
Clinical Child & Adolescent Psychologist	103TC2200X	03 (ID)
Pediatric Neurodevelopmental Disabilities Physician Primary	2080P0008X	03 (ID)

Pediatric Neurodevelopmental Disabilities Physician: A pediatrician who specializes in the treatment of individuals with developmental delays and learning disorders associated with cerebral palsy, spina bifida, autism, and other chronic neurologic conditions.

188 other providers at this address

NPI record

NPI: 1316243330
Entity type: Organization (Type 2)
Issued: Feb 9, 2011
Last updated: Feb 9, 2011
Status: Active
Subpart: Yes of ST Luke's Regional Medical Center

Other names

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ST Luke's Childrens - Neurology · doing business as

Authorized official

John Kee
VP Physician Services
(208) 381-5329

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1316243330

ST Luke's Regional Medical Center's National Provider Identifier is 1316243330, issued on Feb 9, 2011. The primary taxonomy on file is Pediatric Neurodevelopmental Disabilities Physician (2080P0008X), and the practice location is in Boise, ID. The record was last updated on Feb 9, 2011.