Provider Demographics
NPI:1770963225
Name:ST LUKES METHODIST HOSPITAL
Entity type:Organization
Organization Name:ST LUKES METHODIST HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT, COO
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:NIERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-369-8873
Mailing Address - Street 1:202 10TH ST SE
Mailing Address - Street 2:STE 195
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2414
Mailing Address - Country:US
Mailing Address - Phone:319-861-6944
Mailing Address - Fax:319-861-6945
Practice Address - Street 1:202 10TH ST SE
Practice Address - Street 2:STE 195
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2414
Practice Address - Country:US
Practice Address - Phone:319-861-6944
Practice Address - Fax:319-861-6945
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST LUKES METHODIST HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-30
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB3464Medicare PIN