Provider Demographics
NPI:1902476187
Name:SAINT LUKES PHYSICIAN GROUP INC
Entity Type:Organization
Organization Name:SAINT LUKES PHYSICIAN GROUP INC
Other - Org Name:SAINT LUKES PRIMARY CARE AT HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-599-9563
Mailing Address - Street 1:PO BOX 504938
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-4938
Mailing Address - Country:US
Mailing Address - Phone:816-502-8782
Mailing Address - Fax:
Practice Address - Street 1:901 E 104TH ST
Practice Address - Street 2:MAILSTOP 3000E
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-4517
Practice Address - Country:US
Practice Address - Phone:816-502-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT LUKES PHYSICIAN GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-29
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOB940000OtherMEDICARE PIN
MOH720000OtherMEDICARE PIN
KS110403OtherMEDICARE PIN
KSG930000OtherMEDICARE PIN