Provider Demographics
NPI:1700073277
Name:SHARON REGIONAL PHYSICIAN SERVICES
Entity Type:Organization
Organization Name:SHARON REGIONAL PHYSICIAN SERVICES
Other - Org Name:SRPS- BREAST CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-813-8224
Mailing Address - Street 1:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-0004
Mailing Address - Country:US
Mailing Address - Phone:724-347-0861
Mailing Address - Fax:724-347-0864
Practice Address - Street 1:2435 GARDEN WAY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-5211
Practice Address - Country:US
Practice Address - Phone:724-983-5492
Practice Address - Fax:724-983-5950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065330L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA635350Medicare PIN