Provider Demographics
NPI:1255535910
Name:SAINT LUKE'S CATHOLIC MEDICAL SERVICES
Entity type:Organization
Organization Name:SAINT LUKE'S CATHOLIC MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:IDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-342-4131
Mailing Address - Street 1:511 STATE ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08102-1918
Mailing Address - Country:US
Mailing Address - Phone:856-365-4642
Mailing Address - Fax:856-365-0539
Practice Address - Street 1:511 STATE ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102-1918
Practice Address - Country:US
Practice Address - Phone:856-365-4642
Practice Address - Fax:856-365-0539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB064729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ10681OtherAETNA
NJ0865285001OtherAMERIHEALTH
NJ8442002Medicaid
NJDD5461OtherRAILROAD MEDICARE
NJ8442002Medicaid
NJ0865285001OtherAMERIHEALTH