Healthcare Provider Details

I. General information

NPI: 1467502682
Provider Name (Legal Business Name): ST. LUKE'S PHYSICIAN GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2793 GERYVILLE PIKE STE 200
PENNSBURG PA
18073-2306
US

IV. Provider business mailing address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 267-424-8200
  • Fax: 866-395-8159
Mailing address:
  • Phone: 484-526-6048
  • Fax: 833-213-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: DEAN W EVANS
Title or Position: PRESIDENT
Credential:
Phone: 484-526-4911