Provider Demographics
NPI:1245274653
Name:SAINT LUKES HOSPITAL OF CHILLICOTHE
Entity type:Organization
Organization Name:SAINT LUKES HOSPITAL OF CHILLICOTHE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRIMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-891-6000
Mailing Address - Street 1:100 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-1554
Mailing Address - Country:US
Mailing Address - Phone:816-891-6000
Mailing Address - Fax:
Practice Address - Street 1:498 PARK LN
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-1551
Practice Address - Country:US
Practice Address - Phone:660-646-2199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT LUKES HOSPITAL OF CHILLICOTHE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-15
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO069-8HO251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO821965308Medicaid
MO261545Medicare Oscar/Certification