Organization Name: | ST. LUKE'S PHYSICIAN GROUP INC |
NPI Number: | 1134544497 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DEAN W. EVANS (PRESIDENT) |
Mailing Address: | 530 Centre St Ashland |
State: | PA US |
Postal Code: | 179211330 |
Phone Number: | 5708750700 |
Fax Number: | 5708751279 |
NPI Enumeration Date: | 02/24/2014 |
NPI Last Update Date: | 02/24/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |