Healthcare Provider Details

I. General information

NPI: 1437239191
Provider Name (Legal Business Name): ST. LUKE'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 WORNALL RD
KANSAS CITY MO
64111-3238
US

IV. Provider business mailing address

PO BOX 930036
KANSAS CITY MO
64193-0001
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-2392
  • Fax: 816-461-6586
Mailing address:
  • Phone: 816-461-8288
  • Fax: 816-461-6586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: TONYA HACKET
Title or Position: OFFICE MANAGER
Credential:
Phone: 816-932-2392