Provider Demographics
NPI:1275911208
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: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:484-526-6162
Mailing Address - Street 1:511 E 3RD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-2072
Mailing Address - Country:US
Mailing Address - Phone:484-526-4700
Mailing Address - Fax:833-828-1813
Practice Address - Street 1:511 E 3RD ST STE 200
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-2072
Practice Address - Country:US
Practice Address - Phone:484-526-4700
Practice Address - Fax:833-828-1813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA686024Medicare PIN