Provider Demographics
NPI:1477565406
Name:ST. LUKE'S HOSPITAL
Entity Type:Organization
Organization Name:ST. LUKE'S HOSPITAL
Other - Org Name:BOWBELLS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-965-6349
Mailing Address - Street 1:PO BOX C
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:ND
Mailing Address - Zip Code:58730-0658
Mailing Address - Country:US
Mailing Address - Phone:701-965-6349
Mailing Address - Fax:701-965-6407
Practice Address - Street 1:24 MAIN ST. SW #B
Practice Address - Street 2:
Practice Address - City:BOWBELLS
Practice Address - State:ND
Practice Address - Zip Code:58721
Practice Address - Country:US
Practice Address - Phone:701-377-6400
Practice Address - Fax:701-377-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND353436261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12138OtherNORTH DAKOTA BLUE CROSS
ND5142Medicaid
ND353436Medicare ID - Type UnspecifiedRHC MEDICARE