Provider Demographics
NPI:1962594549
Name:ST LUKE'S JONES REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:ST LUKE'S JONES REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIESEMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-462-6131
Mailing Address - Street 1:1795 HIGHWAY 64 E
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-2112
Mailing Address - Country:US
Mailing Address - Phone:319-462-6131
Mailing Address - Fax:319-481-6332
Practice Address - Street 1:1795 HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-2112
Practice Address - Country:US
Practice Address - Phone:319-462-6131
Practice Address - Fax:319-481-6332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST LUKE'S JONES REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-29
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA530110H275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
16Z306Medicare Oscar/Certification