Basic Information
| Provider Information | |||||||||
| NPI: | 1932159688 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPECIALTY PHYSICIANS OF LVHN PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LV HEART AND LUNG SURGEONS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 VALLEY CENTER PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180172344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4848844436 | ||||||||
| FaxNumber: | 4848844444 | ||||||||
| Practice Location | |||||||||
| Address1: | 1240 S CEDAR CREST BLVD | ||||||||
| Address2: | SUITE 403 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181036218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104026896 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 10/02/2007 | ||||||||
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| AuthorizedOfficialLastName: | SZYDLOWSKI | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6104026896 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 20034829 | 01 | PA | AMERIHEALTH MERCY | OTHER | 1537881 | 01 | PA | GATEWAY HEALTH PLAN | OTHER | 1012982100001 | 05 | PA | MEDICAID | 2319685000 | 01 | PA | AMERIHEALTH (IBC) | OTHER | DC1976 | 01 | PA | RAILROAD MEDICARE | OTHER | 3000303 | 01 | PA | KEYSTONE CENTRAL | OTHER | 50039527 | 01 | PA | CAPITAL BLUE CROSS | OTHER |