Provider Demographics
NPI:1932388675
Name:ST LUKES HOPITAL
Entity Type:Organization
Organization Name:ST LUKES HOPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:J
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LOUCKS
Authorized Official - Suffix:
Authorized Official - Credentials:CSCS
Authorized Official - Phone:701-965-6384
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:ND
Mailing Address - Zip Code:58730-0010
Mailing Address - Country:US
Mailing Address - Phone:701-965-6384
Mailing Address - Fax:701-965-4258
Practice Address - Street 1:702 1ST ST SW
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:ND
Practice Address - Zip Code:58730-3329
Practice Address - Country:US
Practice Address - Phone:701-965-6384
Practice Address - Fax:701-965-4258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND716282NC0060X
MT469PT282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access