Provider Demographics
NPI:1376533281
Name:SACRED HEART HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:SACRED HEART HEALTHCARE SYSTEM
Other - Org Name:SACRED HEART MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP LEGAL AFFAIRS
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPEHN
Authorized Official - Middle Name:
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 1:421 W CHEW ST
Practice Address - Street 2:SACRED HEART HOSPITAL
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3406
Practice Address - Country:US
Practice Address - Phone:610-776-5100
Practice Address - Fax:610-663-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03162700OtherCBC GROUP NUMBER
1961959OtherHIGHMARK BLUE SHIELD
5212022OtherAETNA PPO
1052000OtherAMERIHEALTH MERCY HEALTH
1554703OtherGATEWAY
0459718OtherAETNA HMO
CJ0825OtherRR MEDICARE #
1554703OtherGATEWAY
1961959OtherHIGHMARK BLUE SHIELD