Provider Demographics
NPI:1134566409
Name:ST LUKES HOSPITAL OF KANSAS CITY
Entity type:Organization
Organization Name:ST LUKES HOSPITAL OF KANSAS CITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:NACHTIGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-932-2000
Mailing Address - Street 1:4320 WORNALL RD
Mailing Address - Street 2:SUITE 128
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-5941
Mailing Address - Country:US
Mailing Address - Phone:816-932-2188
Mailing Address - Fax:
Practice Address - Street 1:4320 WORNALL RD
Practice Address - Street 2:SUITE 128
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5941
Practice Address - Country:US
Practice Address - Phone:816-932-2188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LUKE'S HOSPITAL OF KANSAS CITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-28
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170045733336C0003X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA4674Medicare Oscar/Certification