Provider Demographics
NPI:1083620199
Name:ST. LUKE'S HOSPITAL
Entity Type:Organization
Organization Name:ST. LUKE'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:O
Authorized Official - Last Name:URVAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-965-6384
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:ND
Mailing Address - Zip Code:58730-0010
Mailing Address - Country:US
Mailing Address - Phone:701-965-6384
Mailing Address - Fax:701-965-4258
Practice Address - Street 1:702 1ST SW
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:ND
Practice Address - Zip Code:58730-0010
Practice Address - Country:US
Practice Address - Phone:701-965-6384
Practice Address - Fax:701-965-4258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5011A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND002923OtherND BLUE CROSS SWINGBED
ND001917Medicaid
ND35-Z325Medicare Oscar/Certification