MEDICARE: ST. LUKE'S HEALTH RESOURCES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1255375556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. LUKE'S HEALTH RESOURCES

Provider Business Mailing Address
First Line	:	2720 STONE PARK BLVD
Second Line	:	ROOM 629
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-3734
Country	:	US
Telephone Number	:	712-279-3380
Fax Number	:	712-279-7015

Provider Business Practice Location Address
First Line	:	224 N DERBY LN
Second Line	:
City	:	NORTH SIOUX CITY
State	:	SD
Zip	:	57049-3016
Country	:	US
Telephone Number	:	605-232-6422
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. MARK A JOHNSON
Credential	:
Telephone Number	:	712-279-3934

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	06/24/2008

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