Basic Information
| Provider Information | |||||||||
| NPI: | 1073787511 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST LUKE HOSPITALS, INC | ||||||||
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| OtherOrganizationName: | PULMONOLOGY SPECIALISTS OF NORTHERN KENTUCKY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 BURNET AVE | ||||||||
| Address2: | 1 RIDGEWAY | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452293019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135859009 | ||||||||
| FaxNumber: | 5135859373 | ||||||||
| Practice Location | |||||||||
| Address1: | 7388 TURFWAY RD | ||||||||
| Address2: | STE. 206 | ||||||||
| City: | FLORENCE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410421381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592124893 | ||||||||
| FaxNumber: | 8592124899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2008 | ||||||||
| LastUpdateDate: | 04/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | TAYLOR | ||||||||
| AuthorizedOfficialFirstName: | KYLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP FINANCIAL OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 5135858494 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 2523200 | 05 | OH | MEDICAID |