1720220858 NPI number — ST. LUKES EPISCOPAL-PRESBYTERIAN HOSPITAL

Table of content: (NPI 1720220858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720220858 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:
1720220858
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
232 S WOODS MILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTERFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63017-3417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-434-1500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 S WOODS MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63017-3509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-205-6612
Provider Business Practice Location Address Fax Number:
314-205-6613
Provider Enumeration Date:
04/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
VICE PRESIDENT-FINANCE / CFO
Authorized Official Telephone Number:
314-434-1500

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  814-HH , 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: 584789408 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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