Provider Demographics
NPI:1275926198
Name:ST. LUKE'S HOSPITAL OF KANSAS CITY
Entity Type:Organization
Organization Name:ST. LUKE'S HOSPITAL OF KANSAS CITY
Other - Org Name:SAINT LUKE'S HOSPITAL INFUSION CENTER AT LIBERTY
Other - Org Type:Doing Business As
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 1:2529 GLENN HENDREN DR
Mailing Address - Street 2:SUITE G30
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-9607
Mailing Address - Country:US
Mailing Address - Phone:816-454-1658
Mailing Address - Fax:
Practice Address - Street 1:2529 GLENN HENDREN DR
Practice Address - Street 2:SUITE G30
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-9607
Practice Address - Country:US
Practice Address - Phone:816-454-1658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LUKES HOSPITAL OF KANSAS CITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-17
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO87-57261QI0500X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO260138Medicare Oscar/Certification