Provider Demographics
NPI:1972749570
Name:ST. LUKE'S HOSPITAL
Entity type:Organization
Organization Name:ST. LUKE'S HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-891-8024
Mailing Address - Street 1:601 WASHINGTON AVE.
Mailing Address - Street 2:COMPREHENSIVE MEDICAL MANAGEMENT
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41018
Mailing Address - Country:US
Mailing Address - Phone:859-655-8554
Mailing Address - Fax:
Practice Address - Street 1:6005 MONCLOVA RD
Practice Address - Street 2:SLH/UT FAMILY MEDICINE RESIDENCY PROGRAM
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537
Practice Address - Country:US
Practice Address - Phone:419-891-8024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LUKE'S HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-02
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7648602Medicaid
OH36-0090Medicare PIN