Provider Demographics
| NPI: | 1306492616 |
|---|---|
| Name: | SAINT LUKES MEMORIAL HOSPITAL INC |
| Entity type: | Organization |
| Organization Name: | SAINT LUKES MEMORIAL HOSPITAL INC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRINCIPAL OFFICIAL FINANCIERA -SS |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | ROSEMARY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | DE LA CRUZ SEVERINO |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 787-864-4300 |
| Mailing Address - Street 1: | PO BOX 336810 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | PONCE |
| Mailing Address - State: | PR |
| Mailing Address - Zip Code: | 00733-6810 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 787-844-2080 |
| Mailing Address - Fax: | 787-844-2090 |
| Practice Address - Street 1: | 917 AVE TITO CASTRO |
| Practice Address - Street 2: | |
| Practice Address - City: | PONCE |
| Practice Address - State: | PR |
| Practice Address - Zip Code: | 00716-4717 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 787-844-2080 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2019-08-13 |
| Last Update Date: | 2024-10-30 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 146M00000X | Emergency Medical Service Providers | Emergency Medical Technician, Intermediate | Group - Multi-Specialty | |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | Group - Multi-Specialty |
| No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
