Provider Demographics
NPI:1770028136
Name:ST. LUKE'S PHYSICIAN GROUP INC.
Entity Type:Organization
Organization Name:ST. LUKE'S PHYSICIAN GROUP INC.
Other - Org Name:ST. LUKE'S ENT ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-526-4911
Mailing Address - Street 1:120 PINE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-1409
Mailing Address - Country:US
Mailing Address - Phone:570-645-1580
Mailing Address - Fax:
Practice Address - Street 1:120 PINE ST
Practice Address - Street 2:SUITE B
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252
Practice Address - Country:US
Practice Address - Phone:570-645-1580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty