Provider Demographics
NPI:1912923285
Name:ST. LUKE'S MEDICAL MINISTRY
Entity Type:Organization
Organization Name:ST. LUKE'S MEDICAL MINISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUNEFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-752-4055
Mailing Address - Street 1:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-0677
Mailing Address - Country:US
Mailing Address - Phone:812-752-4055
Mailing Address - Fax:812-752-5835
Practice Address - Street 1:1441 N GARDNER
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-0677
Practice Address - Country:US
Practice Address - Phone:812-752-4055
Practice Address - Fax:812-752-5835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200841280AMedicaid
IN200841280AOtherMEDICAID RHC
INCI5526OtherRAILROAD MEDICARE
IN153882Medicare Oscar/Certification