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NPI Code Detail

MEDICARE: ST. LUKE'S PHYSICIAN GROUP, INC.

MEDICARE: ST. LUKE'S PHYSICIAN GROUP, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianPA

General Provider Information

NPI Number : 1427169176
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. LUKE'S PHYSICIAN GROUP, INC.
Provider Business Mailing Address
First Line : 801 OSTRUM ST
Second Line :
City : BETHLEHEM
State : PA
Zip : 18015-1000
Country : US
Telephone Number : 610-759-2209
Fax Number : 866-521-0517
Provider Business Practice Location Address
First Line : 305 W NORTH ST
Second Line :
City : NAZARETH
State : PA
Zip : 18064-1308
Country : US
Telephone Number : 610-759-2208
Fax Number : 866-521-0517
Authorized Official
Title or Position : PRESIDENT
Name : DEAN W EVANS
Credential :
Telephone Number : 484-526-4911
Provider Enumeration Date : 08/31/2006
Last Update Date : 01/17/2018

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