Basic Information
| Provider Information | |||||||||
| NPI: | 1336215227 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST LUKE'S SACRED HEART CAMPUS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 CHEW ST | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181023490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107765315 | ||||||||
| FaxNumber: | 6106633107 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 CHEW ST | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107765315 | ||||||||
| FaxNumber: | 6106633107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 06/22/2018 | ||||||||
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| AuthorizedOfficialLastName: | CHIAVAROLI | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | SUPERVISOR ENROLLMENTS | ||||||||
| AuthorizedOfficialTelephone: | 4845263569 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ST. LUKE'S HEALTH NETWORK | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 195501 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.