Provider Demographics
NPI:1518280395
Name:SAINT LUKE'S PHYSICIAN GROUP I, LLC
Entity Type:Organization
Organization Name:SAINT LUKE'S PHYSICIAN GROUP I, LLC
Other - Org Name:SLCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:STASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-599-9587
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-502-8782
Mailing Address - Fax:
Practice Address - Street 1:4330 WORNALL RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5939
Practice Address - Country:US
Practice Address - Phone:816-931-1883
Practice Address - Fax:816-756-3645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSDQ3022OtherRAILROAD MEDICARE
KS200675870BMedicaid
MO1518280395Medicaid
MODQ3775OtherRAILROAD MEDICARE
KS200675870AMedicaid
MO1518280395Medicaid
MOMA2492Medicare PIN
MODQ3775OtherRAILROAD MEDICARE
KSKA2004Medicare PIN