Provider Demographics
NPI:1851326789
Name:SACRED HEART ANCILLARY SERVICES, INC
Entity Type:Organization
Organization Name:SACRED HEART ANCILLARY SERVICES, INC
Other - Org Name:SACRED HEART MEDICAL EQUIPMENT SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-776-4900
Mailing Address - Street 1:2125 28TH ST SW
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-7380
Mailing Address - Country:US
Mailing Address - Phone:610-782-9101
Mailing Address - Fax:610-782-0967
Practice Address - Street 1:2125 28TH ST SW
Practice Address - Street 2:SUITE 400
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-7380
Practice Address - Country:US
Practice Address - Phone:610-782-9101
Practice Address - Fax:610-782-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332B00000X, 332BP3500X
PA3000007257332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007286750004Medicaid
PA1007286750004Medicaid