Provider Demographics
NPI:1972667756
Name:SACRED HEART NEUROLOGY
Entity Type:Organization
Organization Name:SACRED HEART NEUROLOGY
Other - Org Name:SACRED HEART HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:WILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-776-5491
Mailing Address - Street 1:450 W CHEW ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3434
Mailing Address - Country:US
Mailing Address - Phone:610-776-5491
Mailing Address - Fax:610-606-4432
Practice Address - Street 1:450 W CHEW ST
Practice Address - Street 2:SUITE 204
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3434
Practice Address - Country:US
Practice Address - Phone:610-776-5491
Practice Address - Fax:610-606-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018030E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA138182Medicaid