Provider Demographics
NPI:1306589411
Name:ST LUKE'S METHODIST HOSPITAL
Entity type:Organization
Organization Name:ST LUKE'S METHODIST HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-369-7203
Mailing Address - Street 1:1026 A AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5074
Mailing Address - Country:US
Mailing Address - Phone:319-369-7121
Mailing Address - Fax:
Practice Address - Street 1:855 A AVE NE STE LL1
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5064
Practice Address - Country:US
Practice Address - Phone:319-369-7730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST LUKE'S METHODIST HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-16
Last Update Date:2022-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental