Provider Demographics
NPI:1326083304
Name:SAINT LUKES HOSPITAL OF CHILLICOTHE
Entity Type:Organization
Organization Name:SAINT LUKES HOSPITAL OF CHILLICOTHE
Other - Org Name:HEDRICK MEDICAL CENTER - HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRIMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-891-6000
Mailing Address - Street 1:100 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-1554
Mailing Address - Country:US
Mailing Address - Phone:660-646-2199
Mailing Address - Fax:
Practice Address - Street 1:893 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-3673
Practice Address - Country:US
Practice Address - Phone:660-646-2199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT LUKES HOSPITAL OF CHILLICOTHE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO515-9251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO581965308Medicaid
MO581965308Medicaid