Provider Demographics
NPI:1427893486
Name:ST. LUKE'S DES PERES EPISCOPAL-PRESBYTERIAN HOSPITAL
Entity type:Organization
Organization Name:ST. LUKE'S DES PERES EPISCOPAL-PRESBYTERIAN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-434-1500
Mailing Address - Street 1:106 GREGS WAY
Mailing Address - Street 2:
Mailing Address - City:OLD MONROE
Mailing Address - State:MO
Mailing Address - Zip Code:63369-2346
Mailing Address - Country:US
Mailing Address - Phone:636-544-6396
Mailing Address - Fax:
Practice Address - Street 1:2345 DOUGHERTY FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-3313
Practice Address - Country:US
Practice Address - Phone:314-966-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LUKE'S DES PERES HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO010491207Medicaid