Provider Demographics
NPI: | 1134295041 |
---|---|
Name: | ST. LUKE'S HOSPITAL |
Entity Type: | Organization |
Organization Name: | ST. LUKE'S HOSPITAL |
Other - Org Name: | ST. LUKE'S SOUTHSIDE SPECIALTY CLINIC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | ASSOCIATE VP FINANCE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | THOMAS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LICHTENWALNER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 484-526-3383 |
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: | 484-526-3383 |
Mailing Address - Fax: | 484-526-6500 |
Practice Address - Street 1: | 511 E 3RD ST |
Practice Address - Street 2: | SUITE 200 |
Practice Address - City: | BETHLEHEM |
Practice Address - State: | PA |
Practice Address - Zip Code: | 18015-2072 |
Practice Address - Country: | US |
Practice Address - Phone: | 484-526-4700 |
Practice Address - Fax: | 484-526-2074 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-11-24 |
Last Update Date: | 2013-11-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
No | 208C00000X | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | Group - Multi-Specialty | |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 1007552510050 | Medicaid | |
PA | 067434 | Medicare PIN |