Provider Demographics
NPI:1679039556
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:484-526-2538
Mailing Address - Street 1:1251 TURNSTONE DRIVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:FOGELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18051
Mailing Address - Country:US
Mailing Address - Phone:484-822-5155
Mailing Address - Fax:484-822-5164
Practice Address - Street 1:1251 TURNSTONE DRIVE
Practice Address - Street 2:SUITE 230
Practice Address - City:FOGELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18051
Practice Address - Country:US
Practice Address - Phone:484-822-5155
Practice Address - Fax:484-822-5164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty