Provider Demographics
NPI:1083708226
Name:ST LUKE'S METHODIST HOSPITAL
Entity Type:Organization
Organization Name:ST LUKE'S METHODIST HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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 7165
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-7165
Mailing Address - Country:US
Mailing Address - Phone:319-369-7211
Mailing Address - Fax:
Practice Address - Street 1:1026 A AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5036
Practice Address - Country:US
Practice Address - Phone:319-369-7211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA570066H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA60045OtherBLUE CROSS
MO011754306Medicaid
SD0123810Medicaid
IA0600452Medicaid
WI80523600Medicaid
IAA5240619OtherJOHN DEERE
SD5523810Medicaid
IL=========02Medicaid
SD0123810Medicaid
WI80523600Medicaid
IA=========OtherCHAMPUS
MO011754306Medicaid