Provider Demographics
NPI:1598898397
Name:ST LUKES MEDICAL PC
Entity Type:Organization
Organization Name:ST LUKES MEDICAL PC
Other - Org Name:CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CLERICAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:GRINNEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-656-9005
Mailing Address - Street 1:3413 WILMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-3209
Mailing Address - Country:US
Mailing Address - Phone:724-656-9005
Mailing Address - Fax:724-656-9003
Practice Address - Street 1:3413 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-3209
Practice Address - Country:US
Practice Address - Phone:724-656-9005
Practice Address - Fax:724-656-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019582470001Medicaid
PA060002Medicare ID - Type Unspecified
PA060127Medicare ID - Type Unspecified