Organization
ST. LUKE'S PHYSICIAN GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEAN W EVANS (PRESIDENT)
(484) 526-4991
Entity
Organization
Contact information
Practice address
239 E BROWN ST, EAST STROUDSBURG, PA 18301-3005
(570) 421-3872
(570) 424-6631
Mailing address
239 E. BROWN STREET, EAST STROUDSBURG, PA 18301-3005
(570) 421-3872
(570) 424-6631
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
033001
MEDICARE
PA
05
—
1007307530378
—
PA
Enumeration date
04/04/2017
Last updated
03/17/2018
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