Basic Information
| Provider Information | |||||||||
| NPI: | 1700925468 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. LUKE'S HOSPITAL | ||||||||
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| OtherOrganizationName: | ST. LUKE'S KID'S CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 623 E BROAD ST | ||||||||
| Address2: | 2ND FLR | ||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180186332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109546048 | ||||||||
| FaxNumber: | 6109543189 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 UNION STATION PLZ | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180151281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109543060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 12/04/2007 | ||||||||
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| AuthorizedOfficialLastName: | LICHTENWALNER | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSOC VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6109543100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.