Healthcare Provider Details

I. General information

NPI: 1629583844
Provider Name (Legal Business Name): ST. LUKE'S PHYSICIAN GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 03/17/2018
Certification Date:
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: 484-525-7576
  • Fax: 484-526-6674
Mailing address:
  • Phone: 484-525-7576
  • Fax: 484-526-6674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA LEWIS
Title or Position: EXEC. DIRECTOR
Credential:
Phone: 484-526-3571