Provider Demographics
NPI:1003832981
Name:ST. LUKE'S NORTH DIALYSIS CENTER, LP
Entity Type:Organization
Organization Name:ST. LUKE'S NORTH DIALYSIS CENTER, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE VICE PRESIDENT FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:HENRIETTE
Authorized Official - Middle Name:CAROLINE
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-954-3328
Mailing Address - Street 1:801 OSTRUM ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:610-954-3328
Mailing Address - Fax:610-954-6474
Practice Address - Street 1:89 S COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8952
Practice Address - Country:US
Practice Address - Phone:610-954-2888
Practice Address - Fax:610-954-2880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA392696261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA392696Medicare ID - Type Unspecified