Provider Demographics
NPI:1184257826
Name:ST. LUKE'S PHYSICIAN GROUP INC., DBA
Entity type:Organization
Organization Name:ST. LUKE'S PHYSICIAN GROUP INC., DBA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ELISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-526-2538
Mailing Address - Street 1:77 S COMMERCE WAY
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8891
Mailing Address - Country:US
Mailing Address - Phone:484-526-2538
Mailing Address - Fax:833-213-6428
Practice Address - Street 1:2925 WILLIAM PENN HWY STE 104
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5283
Practice Address - Country:US
Practice Address - Phone:484-526-2538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST LUKE'S PHYSICIAN GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty