Basic Information
| Provider Information | |||||||||
| NPI: | 1205088796 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST LUKES PHYSICIAN NETWORK INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 505 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287220505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288943311 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 HOSPITAL DR | ||||||||
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| City: | COLUMBUS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287226418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288943311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2008 | ||||||||
| LastUpdateDate: | 10/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | HIGHSMITH | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8288943311 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ST LUKES HOSPITAL INC | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.