Provider Demographics
NPI:1619932373
Name:ST LUKES HEALTH RESOURCES
Entity Type:Organization
Organization Name:ST LUKES HEALTH RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-279-3934
Mailing Address - Street 1:111 SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:PONCA
Mailing Address - State:NE
Mailing Address - Zip Code:68770
Mailing Address - Country:US
Mailing Address - Phone:402-755-2231
Mailing Address - Fax:402-755-4100
Practice Address - Street 1:111 SECOND STREET
Practice Address - Street 2:
Practice Address - City:PONCA
Practice Address - State:NE
Practice Address - Zip Code:68770
Practice Address - Country:US
Practice Address - Phone:402-755-2231
Practice Address - Fax:402-755-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE283849Medicare Oscar/Certification