Healthcare Provider Details

I. General information

NPI: 1053957688
Provider Name (Legal Business Name): ST. LUKE'S PHYSICIAN GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-4495
  • Fax: 484-526-2419
Mailing address:
  • Phone: 484-526-4495
  • Fax: 484-526-2419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DEAN EVANS
Title or Position: PRESIDENT
Credential:
Phone: 484-526-3383