Provider Demographics
| NPI: | 1134295041 |
|---|---|
| Name: | ST. LUKE'S HOSPITAL |
| Entity type: | Organization |
| Organization Name: | ST. LUKE'S HOSPITAL |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | ASSOCIATE VP FINANCE |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | THOMAS |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | LICHTENWALNER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 484-526-3383 |
| Mailing Address - Street 1: | 801 OSTRUM ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BETHLEHEM |
| Mailing Address - State: | PA |
| Mailing Address - Zip Code: | 18015-1000 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 484-526-3383 |
| Mailing Address - Fax: | 484-526-6500 |
| Practice Address - Street 1: | 511 E 3RD ST |
| Practice Address - Street 2: | SUITE 200 |
| Practice Address - City: | BETHLEHEM |
| Practice Address - State: | PA |
| Practice Address - Zip Code: | 18015-2072 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 484-526-4700 |
| Practice Address - Fax: | 484-526-2074 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-11-24 |
| Last Update Date: | 2013-11-07 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
| No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 208C00000X | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | Group - Multi-Specialty | |
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| PA | 1007552510050 | Medicaid | |
| PA | 067434 | Medicare PIN |