Provider Demographics
NPI:1578525804
Name:SACRED HEART HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:SACRED HEART HEALTHCARE SYSTEM
Other - Org Name:SACRED HEART MEDICAL ASSOCIATES - INFECTIOUS DISEASE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMBERT
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 1:451 W CHEW ST
Practice Address - Street 2:SUITE 301
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3472
Practice Address - Country:US
Practice Address - Phone:610-663-3258
Practice Address - Fax:610-663-3262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50047325OtherCBC GROUP NUMBER
PA459178OtherHIGHMARK BLS GROUP
PA459178OtherHIGHMARK BLS GROUP