1619968096 NPI number — ST LUKES EPISCOPAL PRESBYTERIAN HOSPITAL

Table of content: (NPI 1619968096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619968096 NPI number — ST LUKES EPISCOPAL PRESBYTERIAN HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST LUKES EPISCOPAL PRESBYTERIAN 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:
1619968096
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5551 WINGHAVEN BLVD
Provider Second Line Business Mailing Address:
STE 120
Provider Business Mailing Address City Name:
O FALLON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63368-3617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-695-2555
Provider Business Mailing Address Fax Number:
636-695-2556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5551 WINGHAVEN BLVD
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
O FALLON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63368-3617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-695-2555
Provider Business Practice Location Address Fax Number:
636-695-2556
Provider Enumeration Date:
11/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FOOK
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
DIR OF PHCY SERV
Authorized Official Telephone Number:
314-205-6291

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  2008006746 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 600567515 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2050270 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com