1831202431 NPI number — SAINT LUKES HOSPITAL OF TRENTON

Table of content: (NPI 1831202431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831202431 NPI number — SAINT LUKES HOSPITAL OF TRENTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT LUKES HOSPITAL OF TRENTON
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:
1831202431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
189 IOWA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRENTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64683-8343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-358-5750
Provider Business Mailing Address Fax Number:
660-358-5740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 W 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESPORT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64648-8208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-684-6244
Provider Business Practice Location Address Fax Number:
660-684-6246
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JORDAN
Authorized Official First Name:
GARY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
660-358-5700

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  99778 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: DOR9350 , 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: 508190006 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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