Provider Demographics
NPI:1710314141
Name:ST. LUKES HOSPITAL AT THE VINTAGE
Entity Type:Organization
Organization Name:ST. LUKES HOSPITAL AT THE VINTAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-534-5910
Mailing Address - Street 1:20171 CHASEWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1437
Mailing Address - Country:US
Mailing Address - Phone:832-534-5000
Mailing Address - Fax:
Practice Address - Street 1:20171 CHASEWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1437
Practice Address - Country:US
Practice Address - Phone:832-534-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LUKES HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-30
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100074282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3391534-01Medicaid
TX670075Medicare Oscar/Certification