Provider Demographics
NPI:1225528730
Name:ST. LUKE'S PHYSICIAN GROUP INC.
Entity Type:Organization
Organization Name:ST. LUKE'S PHYSICIAN GROUP INC.
Other - Org Name:WALBERT GYNECOLOGY SERVICES ST. LUKE'S SACRED HEART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MINAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-526-3383
Mailing Address - Street 1:3420 WALBERT AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-1700
Mailing Address - Country:US
Mailing Address - Phone:610-366-8555
Mailing Address - Fax:610-366-8550
Practice Address - Street 1:3420 WALBERT AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-1700
Practice Address - Country:US
Practice Address - Phone:610-366-8555
Practice Address - Fax:610-366-8550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty