Healthcare Provider Details

I. General information

NPI: 1104160746
Provider Name (Legal Business Name): ST LUKES METHODIST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 A AVE NE STE 110
CEDAR RAPIDS IA
52402-5060
US

IV. Provider business mailing address

298 BLAIRS FERRY RD NE
CEDAR RAPIDS IA
52402-1602
US

V. Phone/Fax

Practice location:
  • Phone: 319-369-5114
  • Fax: 319-369-5115
Mailing address:
  • Phone: 319-369-8686
  • Fax: 319-368-8045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0474122
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

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