Healthcare Provider Details

I. General information

NPI: 1194196402
Provider Name (Legal Business Name): ST. LUKE'S PHYSICIAN GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 STATE RD
LEHIGHTON PA
18235-2857
US

IV. Provider business mailing address

770 STATE RD
LEHIGHTON PA
18235-2857
US

V. Phone/Fax

Practice location:
  • Phone: 610-377-9020
  • Fax: 610-377-9784
Mailing address:
  • Phone: 610-377-9020
  • Fax: 610-377-9784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: JOSEPH MINAHAN
Title or Position: PRESIDENT
Credential:
Phone: 484-526-3383