Provider Demographics
| NPI: | 1033160007 |
|---|---|
| Name: | SHARON REGIONAL HEALTH SYSTEM |
| Entity Type: | Organization |
| Organization Name: | SHARON REGIONAL HEALTH SYSTEM |
| Other - Org Name: | SRHS STAFF |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | VICE PRESIDENT, FINANCE |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | JEFF |
| Authorized Official - Middle Name: | A |
| Authorized Official - Last Name: | CHROBAK |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 724-983-3815 |
| Mailing Address - Street 1: | 699 E STATE ST |
| Mailing Address - Street 2: | SRHS STAFF |
| Mailing Address - City: | SHARON |
| Mailing Address - State: | PA |
| Mailing Address - Zip Code: | 16146-2057 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 724-983-3817 |
| Mailing Address - Fax: | 724-983-3941 |
| Practice Address - Street 1: | 740 E STATE ST |
| Practice Address - Street 2: | |
| Practice Address - City: | SHARON |
| Practice Address - State: | PA |
| Practice Address - Zip Code: | 16146-3328 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 724-983-3817 |
| Practice Address - Fax: | 724-983-3941 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | SHARON REGIONAL HEALTH SYSTEM |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-05-15 |
| Last Update Date: | 2010-10-19 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207RS0012X | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | Group - Multi-Specialty |
| No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty | |
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
| No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| PA | 1000000590092 | Medicaid | |
| PA | 920453 | Other | HIGHMARK PATHOLOGIST GROUP |
| PA | 1969743 | Other | HIGHMARK PULMONARY GROUP |
| PA | 1309601 | Other | HIGHMARK ONCOLOGIST GROUP |
| PA | 1325079 | Other | HIGHMARK SECURITY BLUE BEHAVIORAL HEALTH GRP |
| PA | 855908 | Other | HIGHMARK MERCER PCP GROUP |
| 513616 | Medicare ID - Type Unspecified | HOUSE STAFF FOR MEDICARE | |
| PA | 1969743 | Other | HIGHMARK PULMONARY GROUP |
