Provider Demographics
NPI:1326000647
Name:SACRED HEART HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:SACRED HEART HEALTHCARE SYSTEM
Other - Org Name:SUSQUEHANNA MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP LEGAL AFFAIRS
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANSHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-776-5141
Mailing Address - Street 1:421 W CHEW ST
Mailing Address - Street 2:PHYSICIAN ACCOUNTS
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3406
Mailing Address - Country:US
Mailing Address - Phone:610-776-5100
Mailing Address - Fax:610-663-3113
Practice Address - Street 1:124 E SUSQUEHANNA ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-5138
Practice Address - Country:US
Practice Address - Phone:610-797-1600
Practice Address - Fax:610-797-1355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1680744OtherHIGHMARK BLS GROUP NUMBER
2356859001OtherIBC
7661623OtherAETNA PPO
PA50047883OtherCBC GROUP NUMBER
20043807OtherAMERIHEALTH MERCY HEALTH
1545714OtherGATEWAY HEALTH PLAN
3810828OtherAETNA HMO
7661623OtherAETNA PPO