Provider Demographics
NPI:1114220399
Name:SAINT LUKES EAST HOSPITAL
Entity Type:Organization
Organization Name:SAINT LUKES EAST HOSPITAL
Other - Org Name:SAINT LUKE'S EAST HOSPITAL OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-347-5000
Mailing Address - Street 1:100 NE SAINT LUKES BLVD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-6000
Mailing Address - Country:US
Mailing Address - Phone:816-251-5590
Mailing Address - Fax:816-347-5220
Practice Address - Street 1:100 NE SAINT LUKES BLVD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-6000
Practice Address - Country:US
Practice Address - Phone:816-347-4750
Practice Address - Fax:816-347-5220
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT LUKES EAST HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-10
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO20050377683336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO668923351Medicaid
2127571OtherPK