| St. Luke's Treasure Valley Pediatrics | |
|
450 W State St Ste 100 Eagle ID 83616-7055 | |
| (208) 939-1035 | |
| (208) 939-8970 |
| Full Name | St. Luke's Treasure Valley Pediatrics |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 450 W State St Ste 100, Eagle, Idaho |
| Authorized Official Name and Position | Alisha Lauren Miller (FAMILY NURSE PRACTITIONER) |
| Authorized Official Contact | 2089391035 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Luke's Treasure Valley Pediatrics 450 W State St Ste 100 Eagle ID 83616-7055 Ph: (208) 939-1035 | St. Luke's Treasure Valley Pediatrics 450 W State St Ste 100 Eagle ID 83616-7055 Ph: (208) 939-1035 |
| NPI Number | 1396121349 |
|---|---|
| Provider Enumeration Date | 07/31/2015 |
| Last Update Date | 07/31/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396121349 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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