Provider Demographics
NPI:1447609326
Name:ST. LUKE'S EPISCOPAL PRESBYTERIAN HOSPITAL
Entity Type:Organization
Organization Name:ST. LUKE'S EPISCOPAL PRESBYTERIAN HOSPITAL
Other - Org Name:ST. LUKE'S WORKPLACE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FINANCE/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-205-6301
Mailing Address - Street 1:PO BOX 505252
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5252
Mailing Address - Country:US
Mailing Address - Phone:314-205-6474
Mailing Address - Fax:
Practice Address - Street 1:224 S WOODS MILL RD
Practice Address - Street 2:SUITE 360 SOUTH
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3513
Practice Address - Country:US
Practice Address - Phone:314-205-6474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LUKE'S EPISCOPAL PRESBYTERIAN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO274-40282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL19036Medicaid
MO010567600Medicaid
MO010567600Medicaid