OrganizationSt Lukes Regional Medical Center Dba St Luke'S Internal Medicine(<Unavail>)Physician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address300 E Jefferson St, Boise, ID 83712-6246(208) 381-4100PECOS EnrollmentBased on the most recent information from CMS, provider St Lukes Regional Medical Center Dba St Luke'S Internal Medicine does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1790983385Provider TypeOrganizationFull NameSt Lukes Regional Medical Center Dba St Luke'S Internal MedicineOther Name<Unavail>SubpartNoEnumeration Date7/5/2007Last Updated8/22/2020Contact InformationPractice LocationPractice Address300 E Jefferson St, Boise, ID 83712-6246Phone(208) 381-4100Fax(208) 381-4101Mailing LocationMailing AddressPO Box 550, Boise, ID 83701-0550Phone(208) 381-4100Fax(208) 381-4101Authorized OfficialNameCowgill, Carrie Lynne (Credentialing Coordinator)Phone(208) 381-4137Provider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted Issuer