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General NPI Number Information
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NPI Number | 1770845612
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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 | 06/15/2012
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 239 E BROWN ST
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-3005
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Country | US
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Telephone | 570-421-3872
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Fax |
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Provider Business Mailing Address
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Address Line | 239 E BROWN ST
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-3005
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Country | US
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Telephone | 570-421-3872
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Fax |
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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 | 484-526-4991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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