Basic Information
| Provider Information | |||||||||
| NPI: | 1376911024 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT LUKES NEIGHBORHOOD CLINICS LLC | ||||||||
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| OtherOrganizationName: | SAINT LUKE'S CONVENIENT CARE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 E 104TH ST | ||||||||
| Address2: | MAILSTOP 400N | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641314517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165028782 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8501 W 95TH ST | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662123220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133238880 | ||||||||
| FaxNumber: | 9133238881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2015 | ||||||||
| LastUpdateDate: | 03/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | ROBB | ||||||||
| AuthorizedOfficialFirstName: | CHUCK | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR VP CFO SLHS | ||||||||
| AuthorizedOfficialTelephone: | 8169323729 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SAINT LUKES HEALTH SYSTEM INC | ||||||||
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| NPICertificationDate: | 03/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.