Provider Demographics
NPI:1417979469
Name:ST. LUKE'S HOSPITAL-DEPARTMENT OF PEDIATRICS
Entity Type:Organization
Organization Name:ST. LUKE'S HOSPITAL-DEPARTMENT OF PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DETIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-542-4897
Mailing Address - Street 1:224 S WOODS MILL RD
Mailing Address - Street 2:SUITE 210 SOUTH
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3451
Mailing Address - Country:US
Mailing Address - Phone:314-542-4897
Mailing Address - Fax:314-205-6003
Practice Address - Street 1:232 S WOODS MILL RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3417
Practice Address - Country:US
Practice Address - Phone:314-542-4897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren