Provider Demographics
NPI:1952446551
Name:ST. LUKE'S HOSPITAL INC
Entity Type:Organization
Organization Name:ST. LUKE'S HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-894-3311
Mailing Address - Street 1:101 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-6418
Mailing Address - Country:US
Mailing Address - Phone:828-894-0820
Mailing Address - Fax:828-894-5319
Practice Address - Street 1:35 WALKER ST
Practice Address - Street 2:CAP-DA PROGRAM
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-7497
Practice Address - Country:US
Practice Address - Phone:828-894-0564
Practice Address - Fax:828-894-2977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0079251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408360Medicaid