Provider Demographics
NPI:1710469754
Name:ST. LUKE'S WARREN PHYSICIAN GROUP, PC
Entity Type:Organization
Organization Name:ST. LUKE'S WARREN PHYSICIAN GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:908-847-6702
Mailing Address - Street 1:185 ROSEBERRY ST
Mailing Address - Street 2:FARLEY BLDG. 2ND FLOOR
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865
Mailing Address - Country:US
Mailing Address - Phone:908-847-2621
Mailing Address - Fax:908-847-3045
Practice Address - Street 1:187 COUNTY ROAD 519 STE 1
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:NJ
Practice Address - Zip Code:07823-1900
Practice Address - Country:US
Practice Address - Phone:908-847-3418
Practice Address - Fax:908-847-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty