Provider Demographics
NPI:1619169802
Name:SAINT LUKES NORTHLAND HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:SAINT LUKES NORTHLAND HOSPITAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:N.
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:WAGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-880-6500
Mailing Address - Street 1:PO BOX 930945
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64193-0945
Mailing Address - Country:US
Mailing Address - Phone:816-229-8100
Mailing Address - Fax:
Practice Address - Street 1:701 E 1ST ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-2402
Practice Address - Country:US
Practice Address - Phone:660-359-6331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT LUKES NORTHLAND HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7030000BMedicare PIN