1083708226 NPI number — ST LUKE'S METHODIST HOSPITAL

Table of content: (NPI 1083708226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083708226 NPI number — ST LUKE'S METHODIST HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST LUKE'S METHODIST HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083708226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7165
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50309-7165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-369-7211
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1026 A AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52402-5036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-369-7211
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AUNAN
Authorized Official First Name:
MILTON
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
319-369-7094

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  570066H , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 60045 . This is a "BLUE CROSS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 011754306 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0123810 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0600452 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80523600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: A5240619 . This is a "JOHN DEERE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 5523810 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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