Healthcare Provider Details

I. General information

NPI: 1053859280
Provider Name (Legal Business Name): SAINT VINCENT MEDICAL EDUCATION AND RESEARCH INST. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 W 25TH ST
ERIE PA
16544-0002
US

IV. Provider business mailing address

1910 SASSAFRAS ST SUITE 100
ERIE PA
16502-2716
US

V. Phone/Fax

Practice location:
  • Phone: 814-452-5216
  • Fax: 814-452-7005
Mailing address:
  • Phone: 814-452-5216
  • Fax: 814-452-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS MURPHY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 814-452-5310