Provider Demographics
NPI:1922139187
Name:SAINT LUKE'S NORTHLAND HOSPITAL
Entity Type:Organization
Organization Name:SAINT LUKE'S NORTHLAND HOSPITAL
Other - Org Name:SAINT LUKE'S NORHLAND PULMONARY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-532-7763
Mailing Address - Street 1:601 S US HIGHWAY 169
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64089-9317
Mailing Address - Country:US
Mailing Address - Phone:816-532-7164
Mailing Address - Fax:816-532-7163
Practice Address - Street 1:601 S US HIGHWAY 169
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:MO
Practice Address - Zip Code:64089-9317
Practice Address - Country:US
Practice Address - Phone:816-532-7164
Practice Address - Fax:816-532-7163
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT LUKE'S NORTHLAND PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-08
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7030000AMedicare PIN
CS4678Medicare ID - Type UnspecifiedRR MEDICARE PROVIDER