Provider Demographics
NPI:1699429415
Name:ST LUKE'S SURGERY CENTER, LLC
Entity type:Organization
Organization Name:ST LUKE'S SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:KIMBALL
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MHA
Authorized Official - Phone:985-853-0900
Mailing Address - Street 1:249 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2769
Mailing Address - Country:US
Mailing Address - Phone:985-853-0900
Mailing Address - Fax:
Practice Address - Street 1:249 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2769
Practice Address - Country:US
Practice Address - Phone:985-853-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical