Provider Demographics
NPI:1992024103
Name:SAINT LUKES HOSPITAL OF TRENTON
Entity Type:Organization
Organization Name:SAINT LUKES HOSPITAL OF TRENTON
Other - Org Name:WRIGHT MEMORIAL CUSTER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LES
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-359-5621
Mailing Address - Street 1:701 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:64683-2402
Mailing Address - Country:US
Mailing Address - Phone:660-359-5621
Mailing Address - Fax:660-359-4978
Practice Address - Street 1:902 CUSTER ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-2238
Practice Address - Country:US
Practice Address - Phone:660-359-5621
Practice Address - Fax:660-359-4978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207Q00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty