1104160746 NPI number — ST LUKES METHODIST HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104160746 NPI number — ST LUKES METHODIST HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST LUKES 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:
UNITYPOINT AT HOME - HOME MEDICAL EQUIPMENT
Provider Other Organization Name Type Code:
3
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:
1104160746
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
298 BLAIRS FERRY RD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52402-1602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-369-8686
Provider Business Mailing Address Fax Number:
319-368-8045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
855 A AVE NE
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52402-5060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-369-5114
Provider Business Practice Location Address Fax Number:
319-369-5115
Provider Enumeration Date:
11/20/2012

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/VICE PRESIDENT
Authorized Official Telephone Number:
319-369-7094

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0474122 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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