Basic Information
| Provider Information | |||||||||
| NPI: | 1558812594 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST LUKES HOSPITAL CAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287226418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288943311 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287226418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288943311 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2016 | ||||||||
| LastUpdateDate: | 03/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | BROSS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | BEVERLY | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8288940869 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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| NPICertificationDate: | 03/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | H0079 | NC | Y | Hospitals | General Acute Care Hospital | Rural |
ID Information
| ID | Type | State | Issuer | Description | 1871776914 | 01 | BCBS | OTHER | 1245373455 | 05 | NC | MEDICAID | 1760526586 | 01 | NC | BCBS | OTHER | 1760526586 | 05 | NC | MEDICAID | 1306035829 | 05 | NC | MEDICAID | 1316136328 | 01 | NC | BCBS | OTHER | 1427191477 | 01 | NC | BCBS | OTHER | 1427191477 | 05 | NC | MEDICAID | 1144419052 | 01 | NC | BCBS | OTHER | 1245373455 | 05 | SC | MEDICAID | 1497944912 | 05 | NC | MEDICAID | 1760526586 | 05 | SC | MEDICAID | 1497944912 | 05 | SC | MEDICAID | 1245373455 | 01 | NC | BCBS | OTHER | 1306035829 | 05 | SC | MEDICAID | 1427191477 | 05 | SC | MEDICAID |