Healthcare Provider Details

I. General information

NPI: 1871128447
Provider Name (Legal Business Name): MILLCREEK COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 PEACH ST STE 3600
ERIE PA
16509-2601
US

IV. Provider business mailing address

5515 PEACH ST
ERIE PA
16509-2603
US

V. Phone/Fax

Practice location:
  • Phone: 814-868-2170
  • Fax: 814-868-2108
Mailing address:
  • Phone: 814-864-4031
  • Fax: 814-868-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

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