Healthcare Provider Details

I. General information

NPI: 1699186387
Provider Name (Legal Business Name): SAINT LUKE'S HOSPITAL OF TRENTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 E 10TH ST
TRENTON MO
64683-9579
US

IV. Provider business mailing address

189 IOWA BLVD
TRENTON MO
64683-8343
US

V. Phone/Fax

Practice location:
  • Phone: 660-359-3939
  • Fax: 660-359-4372
Mailing address:
  • Phone: 660-358-5750
  • Fax: 660-358-5740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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