Provider Demographics
NPI:1467436683
Name:SAINT LUKE'S HOSPITAL OF TRENTON
Entity Type:Organization
Organization Name:SAINT LUKE'S HOSPITAL OF TRENTON
Other - Org Name:WRIGHT MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-359-5621
Mailing Address - Street 1:701 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:64683-2402
Mailing Address - Country:US
Mailing Address - Phone:660-359-6331
Mailing Address - Fax:
Practice Address - Street 1:605 E 9TH ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-2210
Practice Address - Country:US
Practice Address - Phone:660-359-5621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT LUKE'S HOSPITAL OF TRENTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-01
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO580492205Medicaid
MO580492205Medicaid