NPIMap

Organization Active NPI

St Lukes Episcopal Presbyterian Hospital

  • Community/Retail Pharmacy
  • O Fallon, MO
National Provider Identifier
1619968096
Registry record updated Oct 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
2008006746 Issued in MO
Legal business name
ST LUKES EPISCOPAL PRESBYTERIAN HOSPITAL
Practice address
5551 Winghaven Blvd
Ste 120
O Fallon, MO 63368-3617
Phone
(636) 695-2555
Fax
(636) 695-2556
NPI assigned
Nov 3, 2005
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Richard Fook
Title
Dir of Phcy Serv
Phone
(314) 205-6291

National Provider Directory

National Provider Directory
Tax ID family
Steven F Willey MD11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5551 Winghaven Blvd
Ste 120
O Fallon, MO 63368
Phone (636) 695-2555

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 2008006746 MO Primary

Addresses

NPPES NPI Registry

Primary practice location

5551 Winghaven Blvd
Ste 120
O Fallon, MO 63368-3617

Mailing address

5551 Winghaven Blvd
Ste 120
O Fallon, MO 63368-3617
Phone (636) 695-2555

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
600567515MedicaidMO
2050270OtherPK

Other names 1

NPPES NPI Registry
  • ST LUKES PHARMACY WINGHAVEN Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 12, 2015.

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444608000000",
    "number": "1619968096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5551 WINGHAVEN BLVD",
            "address_2": "STE 120",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633683617",
            "telephone_number": "636-695-2555",
            "fax_number": "636-695-2556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5551 WINGHAVEN BLVD",
            "address_2": "STE 120",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633683617",
            "telephone_number": "636-695-2555",
            "fax_number": "636-695-2556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKES EPISCOPAL PRESBYTERIAN HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-03",
        "last_updated": "2015-10-12",
        "status": "A",
        "authorized_official_last_name": "FOOK",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "DIR OF PHCY SERV",
        "authorized_official_telephone_number": "314-205-6291"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2008006746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600567515",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2050270",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST LUKES PHARMACY WINGHAVEN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in O Fallon, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.