Basic Information
| Provider Information | |||||||||
| NPI: | 1013933175 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST LUKES HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 OSTRUM ST | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180151000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109544000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 OSTRUM ST | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180151000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109544000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 04/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | LICHTENWALNER | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4845263301 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | 451201 | PA | N | Hospitals | General Acute Care Hospital | Children | 282NW0100X | 451201 | PA | N | Hospitals | General Acute Care Hospital | Women | 282N00000X | 451201 | PA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1007552510050 | 05 | PA | MEDICAID | 1007552510053 | 05 | PA | MEDICAID | 1007552510051 | 05 | PA | MEDICAID | 1007552510055 | 05 | PA | MEDICAID | 1007552510059 | 05 | PA | MEDICAID | 1007552510062 | 05 | PA | MEDICAID | 1007552510065 | 05 | PA | MEDICAID | 1007552510064 | 05 | PA | MEDICAID |