Healthcare Provider Details

I. General information

NPI: 1194249920
Provider Name (Legal Business Name): ST LUKE'S JONES REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 CEDAR ST
TIPTON IA
52772-1100
US

IV. Provider business mailing address

1795 HIGHWAY 64 E
ANAMOSA IA
52205-2112
US

V. Phone/Fax

Practice location:
  • Phone: 563-886-2182
  • Fax: 563-886-2732
Mailing address:
  • Phone: 319-462-6131
  • Fax: 319-481-6332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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