Provider Demographics
NPI:1285298737
Name:ST. LUKE'S PHYSICIAN GROUP, INC.
Entity type:Organization
Organization Name:ST. LUKE'S PHYSICIAN GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-526-4999
Mailing Address - Street 1:218A DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-1813
Mailing Address - Country:US
Mailing Address - Phone:610-826-6353
Mailing Address - Fax:610-826-6359
Practice Address - Street 1:218A DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-1813
Practice Address - Country:US
Practice Address - Phone:610-826-6353
Practice Address - Fax:610-826-6359
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LUKE'S PHYSICIAN GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty