Healthcare Provider Details

I. General information

NPI: 1609144344
Provider Name (Legal Business Name): ST LUKES METHODIST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BOYSON RD NE SUITE 2
CEDAR RAPIDS IA
52402-7221
US

IV. Provider business mailing address

1026 A AVE NE
CEDAR RAPIDS IA
52402-5036
US

V. Phone/Fax

Practice location:
  • Phone: 319-369-7990
  • Fax:
Mailing address:
  • Phone: 319-369-8817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0670059
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

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