Provider Demographics
NPI:1063494177
Name:ST LUKES HOSPITAL OF KANSAS CITY
Entity Type:Organization
Organization Name:ST LUKES HOSPITAL OF KANSAS CITY
Other - Org Name:SAINT LUKE'S HOSPITAL OF KANSAS CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANI
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-932-2000
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-932-2000
Mailing Address - Fax:
Practice Address - Street 1:4401 WORNALL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3220
Practice Address - Country:US
Practice Address - Phone:816-932-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO87-48282N00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO010326106Medicaid
KS800057OtherBLUE CROSS
MO90001010OtherBLUE CROSS
516640OtherFIRST GUARD
KS100099590AMedicaid
8840OtherHEALTHCARE USA
700600OtherFAMILY HEALTH PARTNERS
65687OtherAETNA
8840OtherHEALTHCARE USA
=========OtherCHAMPUS
65687OtherAETNA