Healthcare Provider Details

I. General information

NPI: 1144785833
Provider Name (Legal Business Name): ST. LUKE'S WARREN PHYSICIAN GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 ROSEBERRY ST EMERGENCY DEPT
PHILLIPSBURG NJ
08865
US

IV. Provider business mailing address

185 ROSEBERRY ST FARLEY BLDG., 2ND FLOOR
PHILLIPSBURG NJ
08865
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-4789
  • Fax: 484-526-6676
Mailing address:
  • Phone: 908-847-2621
  • Fax: 908-847-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMIE L THOMAS
Title or Position: VICE PRESIDENT MEDICAL AFFAIRS
Credential: DO
Phone: 484-526-4805