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General NPI Number Information
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NPI Number | 1134544497
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Entity Type | Organization
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Legal Business Name | ST. LUKE'S PHYSICIAN GROUP INC
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Dates
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Enumeration Date | 02/24/2014
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Last Update Date | 02/24/2014
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Provider Practice Location Address
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Address Line | 530 CENTRE ST
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City | ASHLAND
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State | PA
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Zip | 17921-1330
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Country | US
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Telephone | 570-875-0700
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Fax | 570-875-1279
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Provider Business Mailing Address
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Address Line | 801 OSTRUM ST
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City | BETHLEHEM
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State | PA
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Zip | 18015-1000
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Country | US
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Telephone | 484-526-6048
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Fax | 484-526-6500
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEAN W. EVANS
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Credential |
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Telephone | 484-526-4911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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