Provider Demographics
NPI:1336215227
Name:ST LUKE'S SACRED HEART CAMPUS
Entity Type:Organization
Organization Name:ST LUKE'S SACRED HEART CAMPUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR ENROLLMENTS
Authorized Official - Prefix:MR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHIAVAROLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-526-3569
Mailing Address - Street 1:421 CHEW ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3490
Mailing Address - Country:US
Mailing Address - Phone:610-776-5315
Mailing Address - Fax:610-663-3107
Practice Address - Street 1:450 CHEW ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102
Practice Address - Country:US
Practice Address - Phone:610-776-5315
Practice Address - Fax:610-663-3107
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LUKE'S HEALTH NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-24
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA195501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA400073Medicare ID - Type UnspecifiedMEDICARE PART B CARRIER