MEDICARE: ST. LUKES HOMESTAR SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	332BX2000X	Oxygen Equipment & Supplies (DME)
3	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1669636155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. LUKES HOMESTAR SERVICES LLC

Provider Business Mailing Address
First Line	:	77 S COMMERCE WAY
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18017-8917
Country	:	US
Telephone Number	:	610-419-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 WELSH RD
Second Line	:	STORE M
City	:	NORTH WALES
State	:	PA
Zip	:	19454-3771
Country	:	US
Telephone Number	:	215-361-9794
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. DOMINICK DESARRO
Credential	:
Telephone Number	:	610-419-7600

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	07/14/2008

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