Basic Information
| Provider Information | |||||||||
| NPI: | 1265486583 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. LUKE'S PRINCETON LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ST. LUKE'S HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1333 SOUTHVIEW DR | ||||||||
| Address2: | |||||||||
| City: | BLUEFIELD | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247014317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043272900 | ||||||||
| FaxNumber: | 3043272906 | ||||||||
| Practice Location | |||||||||
| Address1: | 1333 SOUTHVIEW DR | ||||||||
| Address2: | |||||||||
| City: | BLUEFIELD | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247014317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043272900 | ||||||||
| FaxNumber: | 3043272906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 09/19/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SINICROPE | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3044877263 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 24 | WV | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0001837000 | 05 | WV | MEDICAID | 9810013 | 05 | VA | MEDICAID |