Healthcare Provider Details

I. General information

NPI: 1124685425
Provider Name (Legal Business Name): ST. LUKE'S PHYSICIAN GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 W RUDDLE ST
COALDALE PA
18218-1027
US

IV. Provider business mailing address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-2200
  • Fax: 484-526-2398
Mailing address:
  • Phone: 484-526-3571
  • Fax: 833-213-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMI GIGLIO
Title or Position: ENROLLMENT SPECIALIST
Credential:
Phone: 484-526-3571