Healthcare Provider Details

I. General information

NPI: 1033619804
Provider Name (Legal Business Name): ST LUKE'S JONES REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2018
Last Update Date: 02/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MAIN ST NW
SHELLSBURG IA
52332-9728
US

IV. Provider business mailing address

1795 HIGHWAY 64 E
ANAMOSA IA
52205-2112
US

V. Phone/Fax

Practice location:
  • Phone: 319-436-2040
  • Fax: 319-436-2027
Mailing address:
  • Phone: 319-462-6131
  • Fax: 319-481-6332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC BRIESEMEISTER
Title or Position: CEO
Credential:
Phone: 319-462-6131