Healthcare Provider Details

I. General information

NPI: 1295771921
Provider Name (Legal Business Name): ST. LUKES NORTHLAND HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S 169 HWY
SMITHVILLE MO
64089-9317
US

IV. Provider business mailing address

601 S 169 HWY
SMITHVILLE MO
64089-9317
US

V. Phone/Fax

Practice location:
  • Phone: 816-532-3700
  • Fax:
Mailing address:
  • Phone: 816-532-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateMO

VIII. Authorized Official

Name: JULIE MOORMAN
Title or Position: CFO
Credential:
Phone: 816-532-7164