Basic Information
Provider Information
NPI: 1245809425
EntityType: 2
ReplacementNPI:  
OrganizationName: ST LUKE HOSPITAL
LastName:  
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Credential:  
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Mailing Information
Address1: 801 OSTRUM ST
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180151000
CountryCode: US
TelephoneNumber: 4845264000
FaxNumber:  
Practice Location
Address1: 614 DELAWARE AVE
Address2:  
City: PALMERTON
State: PA
PostalCode: 180712003
CountryCode: US
TelephoneNumber: 4848225320
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/22/2021
LastUpdateDate: 06/22/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LICHTENWALNER
AuthorizedOfficialFirstName: THOMAS
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: SENIOR VP FINANCNE
AuthorizedOfficialTelephone: 4845263383
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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NPICertificationDate: 06/03/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QU0200X  Y Ambulatory Health Care FacilitiesClinic/CenterUrgent Care

No ID Information.


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