1578525804 NPI number — SACRED HEART HEALTHCARE SYSTEM

Table of content: (NPI 1578525804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578525804 NPI number — SACRED HEART HEALTHCARE SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SACRED HEART HEALTHCARE SYSTEM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SACRED HEART MEDICAL ASSOCIATES - INFECTIOUS DISEASE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578525804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
421 W CHEW ST
Provider Second Line Business Mailing Address:
PHYSICIAN ACCOUNTS
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18102-3406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-776-5100
Provider Business Mailing Address Fax Number:
610-663-3113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
451 W CHEW ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18102-3472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-663-3258
Provider Business Practice Location Address Fax Number:
610-663-3262
Provider Enumeration Date:
04/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOMBERT
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
610-776-5141

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50047325 . This is a "CBC GROUP NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 459178 . This is a "HIGHMARK BLS GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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