Provider Demographics
NPI:1184730590
Name:SAINT LUKES HOSPITAL OF TRENTON
Entity type:Organization
Organization Name:SAINT LUKES HOSPITAL OF TRENTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-359-5621
Mailing Address - Street 1:902 CUSTER ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:64683-2238
Mailing Address - Country:US
Mailing Address - Phone:660-339-7294
Mailing Address - Fax:660-339-7925
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:660-339-7294
Practice Address - Fax:660-339-7925
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SATINT LUKES HOSPITAL OF TRENTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-21
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006018921207V00000X
MODOR9350208D00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO508190006Medicaid
268638Medicare Oscar/Certification
MO508190006Medicaid