OrganizationActive
St Lukes Regional Med Ctr Dba St Lukes Pediatric Surgery of Idaho
NPI 1720204738 · Pediatric Surgery Physician · Boise, ID
Provider details
- NPI number
- 1720204738
- Entity type
- Organization
- Primary specialty
- Pediatric Surgery PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Carrie Cowgill, Credentialing Coordinator(208) 381-4137
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
100 E Idaho St
Suite 300
Boise, ID 83712-6223
Phone: (208) 345-5400
Fax: (208) 345-5454
Approximate (ZIP-level) locationGet directions
Mailing address
100 E Idaho St
Boise, ID 83712-6223
Registry dates
- Enumerated
- 2007-04-18
- Last updated
- 2008-04-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.