1144994740 NPI number — ST. LUKE'S PHYSICIAN GROUP, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144994740 NPI number — ST. LUKE'S PHYSICIAN GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. LUKE'S PHYSICIAN GROUP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST. LUKE'S PRIMARY CARE - POCONO SUMMIT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144994740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 OSTRUM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18015-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-526-4000
Provider Business Mailing Address Fax Number:
833-213-6428

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
174 HARVEST LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POCONO SUMMIT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18346-7761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
272-639-5415
Provider Business Practice Location Address Fax Number:
272-639-5431
Provider Enumeration Date:
08/06/2021

Additional Information

Authorized Official

Authorized Official Last Name:
MINAHAN
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
484-526-6048

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com