Provider Demographics
NPI:1558809814
Name:SAINT LUKE'S HOSPITAL OF ALLEN COUNTY, INC
Entity Type:Organization
Organization Name:SAINT LUKE'S HOSPITAL OF ALLEN COUNTY, INC
Other - Org Name:ALLEN COUNTY REGIONAL CLINIC - MORAN
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-365-1026
Mailing Address - Street 1:304 N. CEDAR ST.
Mailing Address - Street 2:
Mailing Address - City:MORAN
Mailing Address - State:KS
Mailing Address - Zip Code:66755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:304 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:MORAN
Practice Address - State:KS
Practice Address - Zip Code:66755-4143
Practice Address - Country:US
Practice Address - Phone:620-237-4205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT LUKE'S HEALTH SYSTEM INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-07
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center