1972667756 NPI number — SACRED HEART NEUROLOGY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972667756 NPI number — SACRED HEART NEUROLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SACRED HEART NEUROLOGY
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 HOSPITAL
Provider Other Organization Name Type Code:
5
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:
1972667756
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:
450 W CHEW ST
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18102-3434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-776-5491
Provider Business Mailing Address Fax Number:
610-606-4432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 W CHEW ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18102-3434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-776-5491
Provider Business Practice Location Address Fax Number:
610-606-4432
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLS
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
DONALD
Authorized Official Title or Position:
NEUROLOGIST
Authorized Official Telephone Number:
610-776-5491

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD018030E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 138182 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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