Provider Demographics
NPI:1295132009
Name:ST. LUKES PHYSICIAN NETWORK, INC
Entity type:Organization
Organization Name:ST. LUKES PHYSICIAN NETWORK, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:WEATHERS
Authorized Official - Last Name:PRESNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-894-0954
Mailing Address - Street 1:PO BOX 602229
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2229
Mailing Address - Country:US
Mailing Address - Phone:828-894-3311
Mailing Address - Fax:
Practice Address - Street 1:101 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-6418
Practice Address - Country:US
Practice Address - Phone:828-894-3311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST LUKES PHYSICIAN NETWORK INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-21
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNPB665Medicaid
NC1295132009Medicaid
NC2335851BMedicare PIN