Healthcare Provider Details

I. General information

NPI: 1649362302
Provider Name (Legal Business Name): ST LUKE'S METHODIST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 A AVE NE
CEDAR RAPIDS IA
52402-5036
US

IV. Provider business mailing address

PO BOX 7165
DES MOINES IA
50309-7165
US

V. Phone/Fax

Practice location:
  • Phone: 319-369-7211
  • Fax:
Mailing address:
  • Phone: 319-369-7211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier65086
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBLUE CROSS

VIII. Authorized Official

Name: MR. MILTON E AUNAN
Title or Position: CFO
Credential:
Phone: 319-369-7094