=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427323849
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST. LUKE'S HOSPITAL - ANDERSON CAMPUS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2012
-----------------------------------------------------
Last Update Date | 02/28/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1872 ST LUKES BLVD
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18045-5669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-503-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1872 ST LUKES BLVD
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18045-5669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-503-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP FINANCE
-----------------------------------------------------
Name | THOMAS LICHTENWALNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 484-526-3301
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 22800101
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------