Provider Demographics
NPI:1578575502
Name:ST LUKE'S HOSPITAL
Entity Type:Organization
Organization Name:ST LUKE'S HOSPITAL
Other - Org Name:LIGNITE 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:701-933-2220
Mailing Address - Fax:701-933-2220
Practice Address - Street 1:115 MAIN ST.
Practice Address - Street 2:
Practice Address - City:LIGNITE
Practice Address - State:ND
Practice Address - Zip Code:58752
Practice Address - Country:US
Practice Address - Phone:701-933-2220
Practice Address - Fax:701-933-2220
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
ND353430261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11726OtherNORTH DAKOTA MEDICAID
ND5126Medicaid
ND5126Medicaid