Healthcare Provider Details

I. General information

NPI: 1962877514
Provider Name (Legal Business Name): SAINT LUKE'S HOSPITAL OF TRENTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N FULLERTON ST
PRINCETON MO
64673-1418
US

IV. Provider business mailing address

191 IOWA BLVD
TRENTON MO
64683-8343
US

V. Phone/Fax

Practice location:
  • Phone: 660-748-4042
  • Fax:
Mailing address:
  • Phone: 660-358-5700
  • Fax:

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 Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAMARA HARPER
Title or Position: VICE PRESIDENT
Credential:
Phone: 816-599-9263