Provider Demographics
NPI:1275852519
Name:SAINT LUKES HOSPITAL OF TRENTON
Entity Type:Organization
Organization Name:SAINT LUKES HOSPITAL OF TRENTON
Other - Org Name:WRIGHT MEMORIAL PHYSICIANS' GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LES
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:660-358-5702
Mailing Address - Street 1:189 IOWA BLVD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:64683-8346
Mailing Address - Country:US
Mailing Address - Phone:660-358-5750
Mailing Address - Fax:660-358-5740
Practice Address - Street 1:189 IOWA BLVD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-8346
Practice Address - Country:US
Practice Address - Phone:660-358-5750
Practice Address - Fax:660-358-5740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD111376207Q00000X, 207VX0000X
MO2007018105207Q00000X
MO7760000B207Q00000X
MOMD105852207R00000X
MO2009026346208600000X
363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1235334624OtherNPI
MO1912930975OtherNPI
MO1720236193OtherNPI
MO1174557672OtherNPI
MO1235334624OtherNPI