Healthcare Provider Details

I. General information

NPI: 1629171780
Provider Name (Legal Business Name): ST LUKES METHODIST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/17/2016
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

1026 A AVE NE
CEDAR RAPIDS IA
52402-5036
US

V. Phone/Fax

Practice location:
  • Phone: 319-369-7528
  • Fax: 319-368-5619
Mailing address:
  • Phone: 319-369-7528
  • Fax: 319-368-5619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1439-43
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number1259
License Number StateIA

VIII. Authorized Official

Name: PATRICK THIES
Title or Position: DIRECTOR OF PHARMACY
Credential: RPH
Phone: 319-368-5861