Provider Demographics
NPI:1003017153
Name:ST LUKES METHODIST HOSPITAL
Entity Type:Organization
Organization Name:ST LUKES METHODIST HOSPITAL
Other - Org Name:FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:E
Authorized Official - Last Name:AUNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-369-7094
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50301-0141
Mailing Address - Country:US
Mailing Address - Phone:319-369-7512
Mailing Address - Fax:319-369-7494
Practice Address - Street 1:4251 RIVER CENTER CT NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-7549
Practice Address - Country:US
Practice Address - Phone:319-369-7512
Practice Address - Fax:319-369-7494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0021691Medicaid
IA0021691Medicaid