Healthcare Provider Details

I. General information

NPI: 1649836057
Provider Name (Legal Business Name): ST. LUKE'S PHYSICIAN GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 N WEST END BLVD
QUAKERTOWN PA
18951-2315
US

IV. Provider business mailing address

237 N WEST END BLVD
QUAKERTOWN PA
18951-2315
US

V. Phone/Fax

Practice location:
  • Phone: 267-985-5060
  • Fax: 833-214-0093
Mailing address:
  • Phone: 267-985-5060
  • Fax: 833-214-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DEAN EVANS
Title or Position: PRESIDENT
Credential:
Phone: 484-526-4999