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DSH130006NV ST LUKES REGIONAL MEDICAL CENTER, LTD. (Active)
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Main Details
Name
ST LUKES REGIONAL MEDICAL CENTER, LTD.
Subdivision Name
ST LUKES CLINIC CENTER FOR ORTHOPEDICS AND SPORTS MEDICINE/REHAB PHYSICAL THERAPY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130006NV
Medicare Provider Number
130006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/7/2021
Participating Start Date
10/1/2021
Participating Approval Date
7/13/2021
Last Recertification Date
8/29/2024
Contacts
Authorizing Official
St. Luke's Health System, LTD
Kate Fowler, Senior VP & CFO
(208) 381-8717
Primary Contact
St. Luke's Health System, LTD
Amanda Davis, Pharmacy Business Analyst
(208) 706-1021
Addresses
Street Address
2619 W FAIRVIEW AVE STE 1104
BOISE, ID 83702
Billing Address
St. Luke's Health System, LTD
190 E Bannock St.
Boise, ID 83712
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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