Basic Information
| Provider Information | |||||||||
| NPI: | 1902910987 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. LUKE HOSPITALS INC | ||||||||
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| OtherOrganizationName: | ST. LUKE PHYSICIANS FOR WOMEN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 ALEXANDRIA PIKE | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND HEIGHTS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410761159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594416300 | ||||||||
| FaxNumber: | 8594416395 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 N GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | FORT THOMAS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410751793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8595723868 | ||||||||
| FaxNumber: | 5135723713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 10/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | SOMMERKAMP | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF FINANCIAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 8595723611 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 363L00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207Q00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207V00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.