Provider Demographics
NPI:1225585532
Name:ST. LUKE COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:ST. LUKE COMMUNITY HOSPITAL
Other - Org Name:ST. LUKE PHYSICAL THERAPY RIDGEWATER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-676-4441
Mailing Address - Street 1:107 RIDGEWATER DR.
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860
Mailing Address - Country:US
Mailing Address - Phone:406-883-2666
Mailing Address - Fax:406-883-2667
Practice Address - Street 1:107 RIDGEWATER DR.
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860
Practice Address - Country:US
Practice Address - Phone:406-883-2666
Practice Address - Fax:406-883-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy