NPI age
12 years
Enumerated 2013-08-07
● Active Type 2 · Organization
Subpart
St Luke'S Magic Valley Regional Medical Center Ltd
St Luke'S Magic Valley Regional Medical Center Ltd is 1 of 55 general acute care hospital organizations in Idaho.
Primary specialty
General Acute Care Hospital
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Fowler
Senior Vp, Cfo
Last NPPES update
2026-04-23
Source: monthly bulk 2026-05
How this organization compares
Across 55 active general acute care hospital providers in Idaho.
NPI age
12 years
↓ 7 yr below median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2013 → 2026
2013-08Enumerated in NPPES
2013
2026
Where they practice
Primary practice location
709 N Lincoln Ave
Jerome, ID 833381851
Mailing address
Po Box 2777
Boise, ID 837012777
Authorized official
Kathryn Fowler
Senior Vp, Cfo
📞 2083818717
Individual providers at this organization
7 individual providers on file at this primary practice address.
- Paul Dickinson, CRNA Nurse Anesthetist, Certified Registered NPI 1912137175
- Curtis Emery, RT (R)(CT) Radiologic Technologist NPI 1942029582
- Anne Fullmer, FNP Nurse Practitioner NPI 1891165569
- Troy Jackman, PHARMD Pharmacist NPI 1609414051
- Brian Johnson, M.D. Family Medicine NPI 1336138783
- Richard Lally, M.D. Emergency Medicine NPI 1750489647
- Thomas Zepeda, MD Personal Emergency Response Attendant NPI 1083833933
Specialties
-
General Acute Care Hospital PrimaryDefinition to come.
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 002287000 |
Other names on file (2)
Doing-business-as, former, and alternate names recorded by NPPES.
-
ST LUKE'S JEROME
-
ST LUKE'S JEROME
Practice context
Multi-provider organization. 7 individual providers on file at this primary address.
Subpart of St Lukes Health System Ltd.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.