Healthcare Provider Details

I. General information

NPI: 1902476187
Provider Name (Legal Business Name): SAINT LUKES PHYSICIAN GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E 104TH ST MAILSTOP 3000E
KANSAS CITY MO
64131-4517
US

IV. Provider business mailing address

PO BOX 504938
SAINT LOUIS MO
63150-4938
US

V. Phone/Fax

Practice location:
  • Phone: 816-502-7000
  • Fax:
Mailing address:
  • Phone: 816-502-8782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JULIE MURPHY
Title or Position: CFO
Credential:
Phone: 816-599-9563