1255401642 NPI number — ST. LUKE HOME HEALTH SERVICES, LLC

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 1255401642 NPI number — ST. LUKE HOME HEALTH SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. LUKE HOME HEALTH SERVICES, LLC
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:
1255401642
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1103
Provider Second Line Business Mailing Address:
P. O. BOX 1103
Provider Business Mailing Address City Name:
MCCOMB
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39649-2735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-249-4260
Provider Business Mailing Address Fax Number:
601-249-4292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCCOMB
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39648-3939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-249-4260
Provider Business Practice Location Address Fax Number:
601-249-4292
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
601-249-1807

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  6081 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000070219 . This is a "BLUECROSSBLUESHIELD" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 03927368 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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