Healthcare Provider Details

I. General information

NPI: 1255375556
Provider Name (Legal Business Name): ST. LUKE'S HEALTH RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 N DERBY LN
NORTH SIOUX CITY SD
57049-3016
US

IV. Provider business mailing address

2720 STONE PARK BLVD ROOM 629
SIOUX CITY IA
51104-3734
US

V. Phone/Fax

Practice location:
  • Phone: 605-232-6422
  • Fax:
Mailing address:
  • Phone: 712-279-3380
  • Fax: 712-279-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

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