Basic Information
| Provider Information | |||||||||
| NPI: | 1619932373 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST LUKES HEALTH RESOURCES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 SECOND STREET | ||||||||
| Address2: | |||||||||
| City: | PONCA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027552231 | ||||||||
| FaxNumber: | 4027554100 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 SECOND STREET | ||||||||
| Address2: | |||||||||
| City: | PONCA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027552231 | ||||||||
| FaxNumber: | 4027554100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 05/06/2008 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT/CFO | ||||||||
| AuthorizedOfficialTelephone: | 7122793934 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.