Provider Demographics
NPI:1104087196
Name:ST LUKE PEDIATRIC CENTER
Entity type:Organization
Organization Name:ST LUKE PEDIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CODER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:859-261-3700
Mailing Address - Street 1:103 LANDMARK DR STE 360
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:KY
Mailing Address - Zip Code:41073-1354
Mailing Address - Country:US
Mailing Address - Phone:859-261-3700
Mailing Address - Fax:859-261-9788
Practice Address - Street 1:103 LANDMARK DR STE 360
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:KY
Practice Address - Zip Code:41073-1354
Practice Address - Country:US
Practice Address - Phone:859-261-3700
Practice Address - Fax:859-261-9788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65915621Medicaid
KY78901709OtherMEDICAID NP GROUP