| St Luke Integrative Medical Center Inc | |
|
415e Church St Nw Ste 4 Huntsville AL 35801-5577 | |
| (256) 801-4536 | |
| Not Available |
| Full Name | St Luke Integrative Medical Center Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 415e Church St Nw Ste 4, Huntsville, Alabama |
| Authorized Official Name and Position | Yvonne C Ortega (OWNER) |
| Authorized Official Contact | 2568014536 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St Luke Integrative Medical Center Inc 415e Church St Nw Ste 4 Huntsville AL 35801-5577 Ph: () - | St Luke Integrative Medical Center Inc 415e Church St Nw Ste 4 Huntsville AL 35801-5577 Ph: (256) 801-4536 |
| NPI Number | 1184282840 |
|---|---|
| Provider Enumeration Date | 05/29/2019 |
| Last Update Date | 07/23/2020 |
| Medicare PECOS PAC ID | 3274963798 |
|---|---|
| Medicare Enrollment ID | O20200424001871 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184282840 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Yvonne C Ortega |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1831185453 PECOS PAC ID: 6002869609 Enrollment ID: I20070206000525 |
| Provider Name | Gary K Adams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487772802 PECOS PAC ID: 9638270390 Enrollment ID: I20070724000818 |
| Provider Name | Angela M Durham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699862474 PECOS PAC ID: 6204950033 Enrollment ID: I20181121000674 |
| Provider Name | Jessica Genovy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437700606 PECOS PAC ID: 5193150084 Enrollment ID: I20200123000953 |
| Provider Name | Elena Mihaela Kruse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003422742 PECOS PAC ID: 3476964164 Enrollment ID: I20201202000459 |
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