| St Luke's Childrens - Neurology | |
|
100 E Idaho St Ste 200 Boise ID 83712-6267 | |
| (208) 381-5000 | |
| (208) 381-5005 |
| Full Name | St Luke's Childrens - Neurology |
|---|---|
| Speciality | Pediatrics - Neurodevelopmental Disabilities |
| Location | 100 E Idaho St, Boise, Idaho |
| Authorized Official Name and Position | John Kee (VP PHYSICIAN SERVICES) |
| Authorized Official Contact | 2083815329 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St Luke's Childrens - Neurology 190 E Bannock St Boise ID 83712-6241 Ph: (208) 381-2222 | St Luke's Childrens - Neurology 100 E Idaho St Ste 200 Boise ID 83712-6267 Ph: (208) 381-5000 |
| NPI Number | 1316243330 |
|---|---|
| Provider Enumeration Date | 02/09/2011 |
| Last Update Date | 02/09/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316243330 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC2200X | Psychologist - Clinical Child & Adolescent | 03 (Idaho) | Secondary |
| 2080P0008X | Pediatrics - Neurodevelopmental Disabilities | 03 (Idaho) | Primary |
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