Healthcare Provider Details

I. General information

NPI: 1053412676
Provider Name (Legal Business Name): SAINT VINCENT MEDICAL EDUCATION AND RESEARCH INSTITUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 BUFFALO RD
ERIE PA
16510-2304
US

IV. Provider business mailing address

153 E 13TH ST STE 1300
ERIE PA
16503-1035
US

V. Phone/Fax

Practice location:
  • Phone: 814-899-7000
  • Fax: 814-899-0334
Mailing address:
  • Phone: 814-452-5772
  • Fax: 814-452-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS MURPHY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 814-452-5216