Basic Information
| Provider Information | |||||||||
| NPI: | 1588043376 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. LUKE'S PHYSICIAN GROUP INC. | ||||||||
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| OtherOrganizationName: | ASC AT ST. LUKE'S HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N 3RD ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | EASTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180421869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845038010 | ||||||||
| FaxNumber: | 4845038009 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 N 3RD ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | EASTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180421869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845038010 | ||||||||
| FaxNumber: | 4845038009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2015 | ||||||||
| LastUpdateDate: | 11/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | EVANS | ||||||||
| AuthorizedOfficialFirstName: | DEAN | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4845264991 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207RI0200X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.