MEDICARE: ST LUKES METHODIST HOSPITAL

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	2083X0100X	Occupational Medicine Physician

General Provider Information

NPI Number	:	1578686341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST LUKES METHODIST HOSPITAL

Provider Business Mailing Address
First Line	:	830 FIRST AVE NE
Second Line	:	ST LUKES WORK WELL SOLUTIONS
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52406-3026
Country	:	US
Telephone Number	:	319-369-8883
Fax Number	:	319-369-7012

Provider Business Practice Location Address
First Line	:	830 FIRST AVE NE
Second Line	:	ST LUKES WORK WELL SOLUTIONS
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52406-3026
Country	:	US
Telephone Number	:	319-369-8883
Fax Number	:	319-369-7012

Authorized Official
Title or Position	:	CFO VICE PRESIDENT
Name	:	MR. JERRY L WORDEN
Credential	:
Telephone Number	:	319-369-7094

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	08/22/2020

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