Basic Information
| Provider Information | |||||||||
| NPI: | 1770086266 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAINT LUKE'S NEIGHBORHOOD CLINICS, LLC | ||||||||
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| OtherOrganizationName: | SAINT LUKE'S REHABILITATION THERAPY | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 E 104TH ST | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641314517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165028782 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2703 RUNNING HORSE RD | ||||||||
| Address2: | |||||||||
| City: | PLATTE CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640797707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165028782 | ||||||||
| FaxNumber: | 8168583253 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2018 | ||||||||
| LastUpdateDate: | 09/25/2019 | ||||||||
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| AuthorizedOfficialLastName: | ROBB | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | SR. VP CFO OF SLHS | ||||||||
| AuthorizedOfficialTelephone: | 8169323729 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SAINT LUKE'S HEALTH SYSTEM INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.