Provider Demographics
NPI:1508262684
Name:ST LUKE'S PHYSICIAN GROUP, INC. DBA ST LUKE'S BETHLEHEM PRIMAY CARE
Entity Type:Organization
Organization Name:ST LUKE'S PHYSICIAN GROUP, INC. DBA ST LUKE'S BETHLEHEM PRIMAY CARE
Other - Org Name:ST LUKE'S PHYSICIAN GROUP, INC. DBA ST LUKE'S BETHLEHEM PRIMAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-526-4911
Mailing Address - Street 1:701 OSTRUM ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:484-526-6400
Mailing Address - Fax:484-526-6405
Practice Address - Street 1:701 OSTRUM ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1000
Practice Address - Country:US
Practice Address - Phone:484-526-6400
Practice Address - Fax:484-526-6405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST LUKE'S PHYSICIAN GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA686024Medicare PIN