Provider Demographics
NPI:1700925468
Name:ST. LUKE'S HOSPITAL
Entity Type:Organization
Organization Name:ST. LUKE'S HOSPITAL
Other - Org Name:ST. LUKE'S KID'S CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOC VICE PRESIDENT
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:610-954-3100
Mailing Address - Street 1:623 E BROAD ST
Mailing Address - Street 2:2ND FLR
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6332
Mailing Address - Country:US
Mailing Address - Phone:610-954-6048
Mailing Address - Fax:610-954-3189
Practice Address - Street 1:240 UNION STATION PLZ
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1281
Practice Address - Country:US
Practice Address - Phone:610-954-3060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA067434Medicare PIN