Basic Information
| Provider Information | |||||||||
| NPI: | 1649462847 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT LUKES NORTHLAND HOSPITAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 930945 | ||||||||
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| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641930945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136841100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 711 MARSHALL ST | ||||||||
| Address2: | |||||||||
| City: | LEAVENWORTH | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660483235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136841100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2007 | ||||||||
| LastUpdateDate: | 08/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | WAGES | ||||||||
| AuthorizedOfficialFirstName: | N | ||||||||
| AuthorizedOfficialMiddleName: | GARY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 8168806500 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SAINT LUKES NORTHLAND HOSPITAL CORPORATION | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.