Basic Information
| Provider Information | |||||||||
| NPI: | 1437271624 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SACRED HEART HOSPITAL OF ALLENTOWN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 W CHEW ST | ||||||||
| Address2: | PHYSICIAN ACCOUNTS | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181023406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107765100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 450 W CHEW ST | ||||||||
| Address2: | SIGAL CENTER 2ND FLOOR | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181023434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107764767 | ||||||||
| FaxNumber: | 6106064476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GOMBERT | ||||||||
| AuthorizedOfficialFirstName: | LAURIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 6107764713 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1517118 | 01 | GATEWAY HEALTH PLAN | OTHER | 1007275420028 | 05 | PA | MEDICAID | 100320 | 01 | AHMHP | OTHER |