Basic Information
| Provider Information | |||||||||
| NPI: | 1437356441 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. LUKE'S HOSPITAL | ||||||||
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| OtherOrganizationName: | ST. LUKE'S SPORTS MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 623 E BROAD ST | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180186332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109546048 | ||||||||
| FaxNumber: | 6109543189 | ||||||||
| Practice Location | |||||||||
| Address1: | 153 BRODHEAD RD | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180178931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109544780 | ||||||||
| FaxNumber: | 6109543216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LICHTENWALNER | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASST VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6109544991 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PS0010X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Sports Medicine | 207QS0010X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 2083S0010X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Sports Medicine |
No ID Information.