Healthcare Provider Details

I. General information

NPI: 1588029276
Provider Name (Legal Business Name): SAINT VINCENT MEDICAL EDUCATION AND RESEARCH INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W 23RD ST SUITE 302A
ERIE PA
16502-2858
US

IV. Provider business mailing address

1910 SASSAFRAS ST SUITE 100
ERIE PA
16502-2716
US

V. Phone/Fax

Practice location:
  • Phone: 814-452-7354
  • Fax: 814-452-7359
Mailing address:
  • Phone: 814-452-5772
  • Fax: 814-452-7818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: THOMAS MURPHY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 814-452-5616