Provider Demographics
NPI:1881178317
Name:ST. LUKE'S PHYSICIAN GROUP, INC.
Entity type:Organization
Organization Name:ST. LUKE'S PHYSICIAN GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMMERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-526-2019
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:484-526-6048
Mailing Address - Fax:833-213-6428
Practice Address - Street 1:543 INTERCHANGE RD
Practice Address - Street 2:
Practice Address - City:KRESGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:18333-7728
Practice Address - Country:US
Practice Address - Phone:610-681-6800
Practice Address - Fax:610-681-6825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty