Provider Demographics
NPI:1679972376
Name:ST. LUKE'S PHYSICIAN GROUP, INC
Entity type:Organization
Organization Name:ST. LUKE'S PHYSICIAN GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CVO SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIAVAROLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-526-3569
Mailing Address - Street 1:1803 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1027
Mailing Address - Country:US
Mailing Address - Phone:570-421-0170
Mailing Address - Fax:570-424-5167
Practice Address - Street 1:1581 N 9TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7576
Practice Address - Country:US
Practice Address - Phone:272-212-4490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty