Provider Demographics
NPI:1588376602
Name:ST LUKES MEDICAL SERVICES PLLC
Entity type:Organization
Organization Name:ST LUKES MEDICAL SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERLENE
Authorized Official - Middle Name:G
Authorized Official - Last Name:CUDIAMAT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:725-292-6829
Mailing Address - Street 1:3100 W SAHARA AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-6001
Mailing Address - Country:US
Mailing Address - Phone:725-292-6829
Mailing Address - Fax:636-212-9019
Practice Address - Street 1:3227 E WARM SPRINGS RD STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3180
Practice Address - Country:US
Practice Address - Phone:725-292-6829
Practice Address - Fax:636-212-9019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty