Healthcare Provider Details

I. General information

NPI: 1992024103
Provider Name (Legal Business Name): SAINT LUKES HOSPITAL OF TRENTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 CUSTER ST
TRENTON MO
64683-2238
US

IV. Provider business mailing address

701 E 1ST ST
TRENTON MO
64683-2402
US

V. Phone/Fax

Practice location:
  • Phone: 660-359-5621
  • Fax: 660-359-4978
Mailing address:
  • Phone: 660-359-5621
  • Fax: 660-359-4978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMO

VIII. Authorized Official

Name: LES REED
Title or Position: CFO
Credential:
Phone: 660-359-5621