1104160746 NPI number — ST LUKES METHODIST HOSPITAL

Table of content: (NPI 1104160746)

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:
Provider Other Organization Name Type Code:
6
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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