Healthcare Provider Details

I. General information

NPI: 1962594549
Provider Name (Legal Business Name): ST LUKE'S JONES REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 HIGHWAY 64 E
ANAMOSA IA
52205-2112
US

IV. Provider business mailing address

1795 HIGHWAY 64 E
ANAMOSA IA
52205-2112
US

V. Phone/Fax

Practice location:
  • Phone: 319-462-6131
  • Fax: 319-481-6332
Mailing address:
  • Phone: 319-462-6131
  • Fax: 319-481-6332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number530110H
License Number StateIA

VIII. Authorized Official

Name: MR. ERIC BRIESEMEISTER
Title or Position: CEO
Credential:
Phone: 319-462-6131