Basic Information
| Provider Information | |||||||||
| NPI: | 1063494177 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST LUKES HOSPITAL OF KANSAS CITY | ||||||||
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| OtherOrganizationName: | SAINT LUKE'S HOSPITAL OF KANSAS CITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 E 104TH ST | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641314517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169322000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4401 WORNALL RD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641113220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169322000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 08/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | JANI | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8169322000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | N | Laboratories | Clinical Medical Laboratory | 282N00000X | 87-48 | MO | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 010326106 | 05 | MO | MEDICAID | 800057 | 01 | KS | BLUE CROSS | OTHER | 90001010 | 01 | MO | BLUE CROSS | OTHER | 516640 | 01 | FIRST GUARD | OTHER | 100099590A | 05 | KS | MEDICAID | 8840 | 01 | HEALTHCARE USA | OTHER | 700600 | 01 | FAMILY HEALTH PARTNERS | OTHER | 65687 | 01 | AETNA | OTHER |