Provider Demographics
NPI:1568884658
Name:SHARON PENNSYLVANIA HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:SHARON PENNSYLVANIA HOSPITAL COMPANY LLC
Other - Org Name:MERCER FAMILY MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:699 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-2057
Mailing Address - Country:US
Mailing Address - Phone:724-983-3820
Mailing Address - Fax:724-983-3941
Practice Address - Street 1:551 GREENVILLE RD
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:PA
Practice Address - Zip Code:16137-5019
Practice Address - Country:US
Practice Address - Phone:724-662-4155
Practice Address - Fax:724-662-2352
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHARON PENNSYLVANIA HOSPITAL COMPANY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-09
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA196601261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
393986Medicare Oscar/Certification