Provider Demographics
NPI:1972043271
Name:SAINT LUKES SOUTH HOSPITAL INC
Entity Type:Organization
Organization Name:SAINT LUKES SOUTH HOSPITAL INC
Other - Org Name:SLS MISSION FARMS PHARMACY
Other - Org Type:Doing Business As
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 1:4061 INDIAN CREEK PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-4030
Mailing Address - Country:US
Mailing Address - Phone:913-323-4777
Mailing Address - Fax:913-323-4778
Practice Address - Street 1:4061 INDIAN CREEK PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-4030
Practice Address - Country:US
Practice Address - Phone:913-323-4777
Practice Address - Fax:913-323-4778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
KS2-1022043336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2168092OtherPK