Provider Demographics
NPI:1699186387
Name:SAINT LUKE'S HOSPITAL OF TRENTON
Entity Type:Organization
Organization Name:SAINT LUKE'S HOSPITAL OF TRENTON
Other - Org Name:SAINT LUKE'S GREEN HILLS MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-358-5700
Mailing Address - Street 1:189 IOWA BLVD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:64683-8343
Mailing Address - Country:US
Mailing Address - Phone:660-358-5750
Mailing Address - Fax:660-358-5740
Practice Address - Street 1:3300 E 10TH ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-9579
Practice Address - Country:US
Practice Address - Phone:660-359-3939
Practice Address - Fax:660-359-4372
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT LUKE'S HOSPITAL OF TRENTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty