Healthcare Provider Details

I. General information

NPI: 1275310591
Provider Name (Legal Business Name): MILLCREEK COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 W 12TH ST
ERIE PA
16505-4204
US

IV. Provider business mailing address

1 LECOM PL
ERIE PA
16505-2571
US

V. Phone/Fax

Practice location:
  • Phone: 814-833-8800
  • Fax: 814-833-2079
Mailing address:
  • Phone: 814-868-2507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEAN NEJMAN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 814-868-2507