Provider Demographics
NPI:1154563385
Name:ST. LUKE'S PHYSICIAN NETWORK INC.
Entity type:Organization
Organization Name:ST. LUKE'S PHYSICIAN NETWORK INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-894-0954
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:704-631-0002
Mailing Address - Fax:
Practice Address - Street 1:89 W MILLS ST
Practice Address - Street 2:STE A
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-9450
Practice Address - Country:US
Practice Address - Phone:828-894-3718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LUKE'S PHYSICIAN NETWORK INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-02
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911666Medicaid
SCNPB303Medicaid
NC1154563385Medicaid
NC2335851AMedicare PIN
NC6340300001Medicare NSC