Provider Demographics
NPI:1396054581
Name:ST. LUKE'S HEALTH RESOURCES
Entity type:Organization
Organization Name:ST. LUKE'S HEALTH RESOURCES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-224-4305
Mailing Address - Street 1:4230 WAR EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51109
Mailing Address - Country:US
Mailing Address - Phone:712-224-4305
Mailing Address - Fax:
Practice Address - Street 1:4230 WAR EAGLE DR
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51109-1700
Practice Address - Country:US
Practice Address - Phone:712-224-4305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LUKE'S HEALTH RESOURCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28886261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine