Healthcare Provider Details

I. General information

NPI: 1215931266
Provider Name (Legal Business Name): MEDICOR ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 2ND ST STE 2
ERIE PA
16507-1537
US

IV. Provider business mailing address

120 E 2ND ST STE 2
ERIE PA
16507-1537
US

V. Phone/Fax

Practice location:
  • Phone: 814-456-8980
  • Fax: 814-451-0443
Mailing address:
  • Phone: 814-456-8980
  • Fax: 814-451-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberCARDIOLOGY
License Number StatePA

VIII. Authorized Official

Name: CHARLES M FURR
Title or Position: CORPORATION PRESIDENT
Credential: M.D.
Phone: 814-456-8980