Provider Demographics
NPI:1891120879
Name:ST. LUKE'S PHYSICIAN GROUP INC
Entity Type:Organization
Organization Name:ST. LUKE'S PHYSICIAN GROUP INC
Other - Org Name:ST. LUKE'S NORTHERN VALLEY PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIAVAROLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-526-3569
Mailing Address - Street 1:801 OSTRUM ST
Mailing Address - Street 2:ENROLLMENT CENTER
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:484-526-6048
Mailing Address - Fax:484-526-6500
Practice Address - Street 1:602 E 21ST ST STE 400
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18067-1269
Practice Address - Country:US
Practice Address - Phone:484-526-7275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2022-10-13
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
PA686024KHDMedicare PIN