St Lukes Clinic - Wood River LLC
NPI 1972891604ActiveOrganization· Internal Medicine· Ketchum, ID
Internal Medicine in Ketchum, Idaho, registered in NPPES in July 2011, part of St Lukes Medical Center Woodriver Ltd. The authorized official on file is Kathryn Fowler, Senior Vp, Cfo. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1972891604 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | St Lukes Medical Center Woodriver Ltd |
| NPI issued | Jul 15, 2011 |
| Last updated in NPPES | Apr 23, 2026 |
| Certified by provider | Apr 23, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Internal Medicine Primary | 207R00000X | 62 | ID |
| Anesthesiology | 207L00000X | 62 | ID |
| Emergency Medicine | 207P00000X | 62 | ID |
| Family Medicine | 207Q00000X | 62 | ID |
| Obstetrics & Gynecology | 207V00000X | 62 | ID |
| Orthopaedic Surgery | 207X00000X | 62 | ID |
| Urology | 208800000X | 62 | ID |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (ID) |
|---|
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