NPIMap

Organization Active NPI

Saint Lukes Hospital of Trenton

Doing business as Wright Memorial Custer Street Clinic

  • Rural Health Clinic/Center
  • Trenton, MO
National Provider Identifier
1184730590
Registry record updated Feb 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SAINT LUKES HOSPITAL OF TRENTON
Doing business as
Wright Memorial Custer Street Clinic
Practice address
902 Custer St
Trenton, MO 64683-2238
Phone
(660) 339-7294
Fax
(660) 339-7925
NPI assigned
Aug 21, 2006
Last updated
Feb 1, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
SATINT LUKES HOSPITAL OF TRENTONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 1, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Karen S Cole
Title
Chief Executive Officer
Phone
(660) 359-5621

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X 2006018921 MO
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X DOR9350 MO
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

902 Custer St
Trenton, MO 64683-2238

Mailing address

902 Custer St
Trenton, MO 64683-2238
Phone (660) 339-7294

Other names 1

  • Wright Memorial Custer Street Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040327000339 MO Part B Supplier - Clinic/Group Practice 3971495532 Receives reassigned benefits from 159 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Princeton, MO; Trenton, MO

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Wright Memorial Hosp Crna

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264982400000",
    "number": "1184730590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 CUSTER ST",
            "city": "TRENTON",
            "state": "MO",
            "postal_code": "646832238",
            "telephone_number": "660-339-7294",
            "fax_number": "660-339-7925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 CUSTER ST",
            "city": "TRENTON",
            "state": "MO",
            "postal_code": "646832238",
            "telephone_number": "660-339-7294",
            "fax_number": "660-339-7925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT LUKES HOSPITAL OF TRENTON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SATINT LUKES HOSPITAL OF TRENTON",
        "enumeration_date": "2006-08-21",
        "last_updated": "2010-02-01",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "660-359-5621"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "MO",
            "license": "2006018921",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "MO",
            "license": "DOR9350",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wright Memorial Custer Street Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Trenton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.