| NPI | 1770886384 |
|---|---|
| Doing Business As | ST LUKE'S 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 | 207V00000X Obstetrics & Gynecology (Licence: ID 11) |
| 363L00000X Nurse Practitioner (Licence: ID 11) | |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2010-12-21 |