Provider Demographics
NPI:1689164196
Name:ST. LUKE'S PHYSICIAN GROUP INC.
Entity Type:Organization
Organization Name:ST. LUKE'S PHYSICIAN GROUP INC.
Other - Org Name:OB/GYN ASSOCIATES OF 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 1:450 CHEW ST STE 204
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3434
Mailing Address - Country:US
Mailing Address - Phone:610-776-4758
Mailing Address - Fax:610-820-5754
Practice Address - Street 1:450 CHEW ST STE 204
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3434
Practice Address - Country:US
Practice Address - Phone:610-776-4758
Practice Address - Fax:610-820-5754
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
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty