Healthcare Provider Details

I. General information

NPI: 1831202431
Provider Name (Legal Business Name): SAINT LUKES HOSPITAL OF TRENTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W 2ND ST
JAMESPORT MO
64648-8208
US

IV. Provider business mailing address

189 IOWA BLVD
TRENTON MO
64683-8343
US

V. Phone/Fax

Practice location:
  • Phone: 660-684-6244
  • Fax: 660-684-6246
Mailing address:
  • Phone: 660-358-5750
  • Fax: 660-358-5740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number99778
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDOR9350
License Number StateMO

VIII. Authorized Official

Name: GARY W JORDAN
Title or Position: CEO
Credential:
Phone: 660-358-5700