Basic Information
| Provider Information | |||||||||
| NPI: | 1578051116 | ||||||||
| 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: | |||||||||
| City: | PHILLIPSBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088651690 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 755 MEMORIAL PKWY STE 302 | ||||||||
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| City: | PHILLIPSBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088652771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9088472621 | ||||||||
| FaxNumber: | 9088473045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2018 | ||||||||
| LastUpdateDate: | 05/08/2018 | ||||||||
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| AuthorizedOfficialLastName: | THOMAS | ||||||||
| AuthorizedOfficialFirstName: | JAMIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF MEDICAL AFFAIRS | ||||||||
| AuthorizedOfficialTelephone: | 9088472621 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 207QB0002X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Bariatric Medicine |
No ID Information.