Basic Information
| Provider Information | |||||||||
| NPI: | 1538631056 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. LUKE'S WARREN PHYSICIAN GROUP, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 ROSEBERRY ST | ||||||||
| Address2: | FARLEY BLDG., 2ND FLOOR | ||||||||
| City: | PHILLIPSBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9088472621 | ||||||||
| FaxNumber: | 9088473045 | ||||||||
| Practice Location | |||||||||
| Address1: | 185 ROSEBERRY ST | ||||||||
| Address2: | INFECTIOUS DISEASE DEPT | ||||||||
| City: | PHILLIPSBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845266200 | ||||||||
| FaxNumber: | 8332229421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2018 | ||||||||
| LastUpdateDate: | 01/23/2019 | ||||||||
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| AuthorizedOfficialLastName: | THOMAS | ||||||||
| AuthorizedOfficialFirstName: | JAMIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF MEDICAL AFFAIRS4 | ||||||||
| AuthorizedOfficialTelephone: | 4845264805 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.