Provider Demographics
| NPI: | 1740241421 |
|---|---|
| Name: | SACRED HEART HEALTHCARE SYSTEM |
| Entity Type: | Organization |
| Organization Name: | SACRED HEART HEALTHCARE SYSTEM |
| Other - Org Name: | |
| Other - Org Type: | |
| 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: | 610-776-5315 |
| Mailing Address - Fax: | 610-663-3107 |
| Practice Address - Street 1: | 421 CHEW ST |
| Practice Address - Street 2: | |
| Practice Address - City: | ALLENTOWN |
| Practice Address - State: | PA |
| Practice Address - Zip Code: | 18102-3406 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 610-776-5315 |
| Practice Address - Fax: | 610-663-3107 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-03-31 |
| Last Update Date: | 2015-06-04 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207VG0400X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | Group - Multi-Specialty |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
| No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| PA | 459178 | Other | HIGHMARK BLS GROUP |
| CJ0825 | Other | RR MEDICARE GROUP | |
| 20033759 | Other | AMERIHEALTH MERCY HEALTH | |
| 5212022 | Other | AETNA PPO | |
| 1514632 | Other | GATEWAY HEALTH PLAN | |
| 0679828000 | Other | IBC | |
| PA | 50047325 | Other | CBC GROUP NUMBER |
| 0459718 | Other | AETNA HMO | |
| PA | 174971 | Medicare PIN | |
| 5212022 | Other | AETNA PPO | |
| CJ0825 | Other | RR MEDICARE GROUP | |
| PA | 459178 | Medicare PIN | |
| PA | 404651 | Medicare PIN | |
| 1514632 | Other | GATEWAY HEALTH PLAN | |
| PA | CD1942 | Medicare PIN |
