# ST. LUKE'S PHYSICIAN GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639554942
- **Authorized official:** DEAN W. EVANS (PRESIDENT)
- **Authorized official phone:** (484) 526-4991

## Contact information

- **Practice address:** 2599 STATE ROUTE 903, ALBRIGHTSVILLE, PA 18210
- **Practice address phone:** (570) 645-1945
- **Practice address fax:** (570) 645-1946
- **Mailing address:** 2599 STATE ROUTE 903, ALBRIGHTSVILLE, PA 18210-3756
- **Mailing address phone:** (570) 645-1945
- **Mailing address fax:** (570) 645-1946

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/28/2015
- **Last updated:** 02/07/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 686024 | MEDICARE GROUP | PA |