Provider Demographics
NPI:1316485725
Name:ST. LUKE'S COMMUNITY HEALTH SERVICES
Entity type:Organization
Organization Name:ST. LUKE'S COMMUNITY HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-266-9104
Mailing Address - Street 1:10710 KUYKENDAHL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381
Mailing Address - Country:US
Mailing Address - Phone:936-266-9104
Mailing Address - Fax:
Practice Address - Street 1:10710 KUYKENDAHL RD
Practice Address - Street 2:SUITE B
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381
Practice Address - Country:US
Practice Address - Phone:936-266-9104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LUKE'S HEALTH SYSTEM CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130312261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical