St. Luke'S Physician Group, Inc.

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

Legal business name

ST. LUKE'S PHYSICIAN GROUP, INC.

Practice address

701 Ostrum St
Suite 102
Fountain Hill, PA 18015-1155

Phone

(610) 954-4960

Fax

(610) 954-3162

NPI assigned

Jul 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dean W Evans

Title

President

Phone

(610) 954-3383

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• St. Luke's Center for Pelvic Health Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271289600000",
    "number": "1124034517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 OSTRUM ST",
            "address_2": "SUITE 102",
            "city": "FOUNTAIN HILL",
            "state": "PA",
            "postal_code": "180151155",
            "telephone_number": "610-954-4960",
            "fax_number": "610-954-3162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 OSTRUM ST",
            "address_2": "SUITE 102",
            "city": "FOUNTAIN HILL",
            "state": "PA",
            "postal_code": "180151155",
            "telephone_number": "610-954-4960",
            "fax_number": "610-954-3162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LUKE'S PHYSICIAN GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2010-04-15",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "610-954-3383"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007307530190",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Luke's Center for Pelvic Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• St. Luke'S Physician Group Inc
• St. Luke'S Physician Group Inc
• St. Luke'S Physician Group Inc.
• St. Luke'S Physician Group, Inc
• St. Luke'S Physician Group, Inc.
• St. Luke'S Physician Group, Inc.
• St. Luke'S Physician Group, Inc.
• St. Luke'S Physician Group, Inc.
• St. Luke'S Physician Group, Inc.
• St. Luke'S Physician Group, Inc.

• Gynecology Physician in Fountain Hill, PA
• Providers in Fountain Hill, PA by specialty
• Gynecology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.