Provider Demographics
NPI:1497152037
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:W
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-526-4991
Mailing Address - Street 1:1114 E CATAWISSA ST
Mailing Address - Street 2:
Mailing Address - City:NESQUEHONING
Mailing Address - State:PA
Mailing Address - Zip Code:18240-1805
Mailing Address - Country:US
Mailing Address - Phone:570-645-1920
Mailing Address - Fax:570-645-1925
Practice Address - Street 1:1114 E CATAWISSA ST
Practice Address - Street 2:
Practice Address - City:NESQUEHONING
Practice Address - State:PA
Practice Address - Zip Code:18240-1805
Practice Address - Country:US
Practice Address - Phone:570-645-1920
Practice Address - Fax:866-263-1962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD449942207R00000X, 208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty