Healthcare Provider Details

I. General information

NPI: 1003017153
Provider Name (Legal Business Name): ST LUKES METHODIST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251 RIVER CENTER CT NE
CEDAR RAPIDS IA
52402-7549
US

IV. Provider business mailing address

PO BOX 141
DES MOINES IA
50301-0141
US

V. Phone/Fax

Practice location:
  • Phone: 319-369-7512
  • Fax: 319-369-7494
Mailing address:
  • Phone: 319-369-7512
  • Fax: 319-369-7494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

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