Provider Demographics
NPI:1598289316
Name:ST LUKE'S JONES REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:ST LUKE'S JONES REGIONAL MEDICAL CENTER
Other - Org Name:UNITYPOINT HEALTH-FAMILY MEDICINE CLINIC-CLARENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIESEMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-462-6131
Mailing Address - Street 1:1795 HIGHWAY 64 E
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-2112
Mailing Address - Country:US
Mailing Address - Phone:319-462-6131
Mailing Address - Fax:319-481-6332
Practice Address - Street 1:411 1ST AVE
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:IA
Practice Address - Zip Code:52216-9744
Practice Address - Country:US
Practice Address - Phone:563-452-3211
Practice Address - Fax:563-452-3215
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST LUKE'S JONES REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty