Provider Demographics
NPI:1790767812
Name:SAINT LUKES SOUTH HOSPITAL, INC.
Entity Type:Organization
Organization Name:SAINT LUKES SOUTH HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-347-4782
Mailing Address - Street 1:PO BOX 503820
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-0001
Mailing Address - Country:US
Mailing Address - Phone:913-317-7000
Mailing Address - Fax:913-317-7000
Practice Address - Street 1:12300 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1324
Practice Address - Country:US
Practice Address - Phone:913-317-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT LUKES SOUTH HOSPITAL , INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-15
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO013990007Medicaid
KS100332210AMedicaid
KS17T185Medicare Oscar/Certification