Basic Information
| Provider Information | |||||||||
| NPI: | 1801364989 | ||||||||
| 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: | 200 STRYKERS RD | ||||||||
| Address2: | |||||||||
| City: | PHILLIPSBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088659488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9088471035 | ||||||||
| FaxNumber: | 9088471040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2018 | ||||||||
| LastUpdateDate: | 07/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | KEMMERER | ||||||||
| AuthorizedOfficialFirstName: | KRISTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4845263569 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.