Provider Demographics
NPI:1336213446
Name:ST LUKES COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:ST LUKES COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-676-4441
Mailing Address - Street 1:107 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-2634
Mailing Address - Country:US
Mailing Address - Phone:406-676-4441
Mailing Address - Fax:406-676-0835
Practice Address - Street 1:107 6TH AVE SW
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-2634
Practice Address - Country:US
Practice Address - Phone:406-676-4441
Practice Address - Fax:406-676-0835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10834282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0412711Medicaid
MT271325Medicare Oscar/Certification
MT27Z325Medicare Oscar/Certification