Provider Demographics
NPI:1417043092
Name:ST. LUKE'S HEALTH ALLIANCE
Entity Type:Organization
Organization Name:ST. LUKE'S HEALTH ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:PHILLIPS
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:508-385-0890
Mailing Address - Street 1:900 ROUTE 134
Mailing Address - Street 2:BUILDING #1
Mailing Address - City:SOUTH DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02660
Mailing Address - Country:US
Mailing Address - Phone:508-385-0890
Mailing Address - Fax:
Practice Address - Street 1:900 ROUTE 134
Practice Address - Street 2:BUILDING #1
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660
Practice Address - Country:US
Practice Address - Phone:508-385-0890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty