Provider Demographics
NPI:1326008228
Name:SACRED HEART HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:SACRED HEART HEALTHCARE SYSTEM
Other - Org Name:HANOVER FAMILY MEDICAL GROUP
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 1:1210 HANOVER AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-2017
Practice Address - Country:US
Practice Address - Phone:610-437-6490
Practice Address - Fax:610-437-4151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
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
1519695OtherGATEWAY ASSURED
PA564229OtherHIGHMARK BLS GROUP #
0006472OtherAETNA HMO
0218423001OtherIBC
PA02400200OtherCBC GROUP #
5844495OtherAETNA PPO
47661OtherAMERIHEALTH MERCY HEALTH
5844495OtherAETNA PPO
47661OtherAMERIHEALTH MERCY HEALTH