Healthcare Provider Details

I. General information

NPI: 1104906874
Provider Name (Legal Business Name): SAINT VINCENT MEDICAL EDUCATION AND RESEARCH INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W 23RD ST SUITE 202
ERIE PA
16502-2858
US

IV. Provider business mailing address

3530 PEACH ST SUITE LL1
ERIE PA
16508-2768
US

V. Phone/Fax

Practice location:
  • Phone: 814-451-8008
  • Fax: 814-456-1528
Mailing address:
  • Phone: 814-860-5000
  • Fax: 814-860-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANA BOATMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 814-452-5264