Healthcare Provider Details

I. General information

NPI: 1508104894
Provider Name (Legal Business Name): ST. LUKE'S PHYSICIAN GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 OSTRUM ST SUITE 501
FOUNTAIN HILL PA
18015-1155
US

IV. Provider business mailing address

701 OSTRUM ST SUITE 501
FOUNTAIN HILL PA
18015-1155
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-6161
  • Fax: 484-526-6385
Mailing address:
  • Phone: 484-526-6161
  • Fax: 484-526-6385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

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