Basic Information
| Provider Information | |||||||||
| NPI: | 1437695095 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. LUKE'S PHYSICIAN GROUP INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 OSTRUM ST STE 103 | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180151152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845266200 | ||||||||
| FaxNumber: | 8332229421 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 OSTRUM ST STE 103 | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180151152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845266200 | ||||||||
| FaxNumber: | 8332229421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2017 | ||||||||
| LastUpdateDate: | 01/22/2018 | ||||||||
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| AuthorizedOfficialLastName: | MINAHAN | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4845266162 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.