| NPI | 1245503614 |
|---|---|
| Doing Business As | ST LUKES PAYETTE LAKES MEDICAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | JEFF TAYLOR System VP CFO 208-381-2520 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 11) |
| Additional Taxonomies | 207QA0000X Family Medicine Adolescent Medicine (Licence: ID 11) |
| 207QA0505X Family Medicine Adult Medicine (Licence: ID 11) | |
| Enumeration Date | 2012-02-16 |
| Last Update Date | 2012-02-16 |