Organization
SAINT LUKE'S PHYSICIAN GROUP I, LLC
Active
Other names
SLCC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH P STASI (CAO)
(816) 599-9587
Entity
Organization
Contact information
Practice address
4330 WORNALL RD, SUITE 2000, KANSAS CITY, MO 64111-5939
(816) 931-1883
(816) 756-3645
Mailing address
901 E 104TH ST, MAILSTOP 400, KANSAS CITY, MO 64131-4517
(816) 502-8782
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518280395
—
MO
05
—
200675870A
—
KS
05
—
200675870B
—
KS
01
—
DQ3022
RAILROAD MEDICARE
KS
01
—
DQ3775
RAILROAD MEDICARE
MO
Enumeration date
03/08/2010
Last updated
04/12/2017
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