MEDICARE: SACRED HEART HEALTHCARE 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1526559	OTHER	GATEWAY HEALTH PLAN
2	20051975	OTHER	AMERIHEALTH MERCY HEALTH
3	1233437	OTHER	AETNA HMO
4	2695601001	OTHER	IBC
5	50063077	OTHER	CBC
6	7059781	OTHER	AETNA PPO
7	1835377	OTHER	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1932169885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED HEART HEALTHCARE SYSTEM

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

Provider Business Practice Location Address
First Line	:	2416 3RD ST
Second Line	:
City	:	WHITEHALL
State	:	PA
Zip	:	18052-4822
Country	:	US
Telephone Number	:	610-264-2188
Fax Number	:	610-264-3391

Authorized Official
Title or Position	:	VP LEGAL AFFAIRS
Name	:	MR. STEPHEN A LANSHE
Credential	:
Telephone Number	:	610-776-5141

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	02/25/2009

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Directions to “SACRED HEART HEALTHCARE SYSTEM ” Practice Location

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