Healthcare Provider Details

I. General information

NPI: 1619932373
Provider Name (Legal Business Name): ST LUKES HEALTH RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SECOND STREET
PONCA NE
68770
US

IV. Provider business mailing address

111 SECOND STREET
PONCA NE
68770
US

V. Phone/Fax

Practice location:
  • Phone: 402-755-2231
  • Fax: 402-755-4100
Mailing address:
  • Phone: 402-755-2231
  • Fax: 402-755-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK A JOHNSON
Title or Position: VICE PRESIDENT/CFO
Credential:
Phone: 712-279-3934