MEDICARE: SHARON REGIONAL HEALTH SYSTEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1041822	OTHER	GATEWAY
2	000000068169	OTHER	UNISON
3	33066	OTHER	HEALTH AMERICA
4	855908	OTHER	HIGHMARK PCP CONTRACT

General Provider Information

NPI Number	:	1053351619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARON REGIONAL HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	699 E STATE ST
Second Line	:
City	:	SHARON
State	:	PA
Zip	:	16146-2057
Country	:	US
Telephone Number	:	724-983-3817
Fax Number	:	724-983-3941

Provider Business Practice Location Address
First Line	:	551 GREENVILLE RD
Second Line	:	SRHS MERCER FAMILY MEDICINE CENTER
City	:	MERCER
State	:	PA
Zip	:	16137-5019
Country	:	US
Telephone Number	:	724-662-4155
Fax Number	:	724-662-2352

Authorized Official
Title or Position	:	VICE PRESIDENT, FINANCE
Name	:	MR. JEFF A CHROBAK
Credential	:
Telephone Number	:	724-983-3815

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	08/13/2007

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Directions to “SHARON REGIONAL HEALTH SYSTEM ” Practice Location

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