Healthcare Provider Details

I. General information

NPI: 1124210687
Provider Name (Legal Business Name): SAINT VINCENT SURGERY CENTER OF ERIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W 25TH ST
ERIE PA
16502-2624
US

IV. Provider business mailing address

312 W 25TH ST
ERIE PA
16502-2624
US

V. Phone/Fax

Practice location:
  • Phone: 814-452-7010
  • Fax: 814-452-7059
Mailing address:
  • Phone: 814-452-7010
  • Fax: 814-452-7059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number4561500
License Number StatePA

VIII. Authorized Official

Name: MR. THOMAS ELLIOTT
Title or Position: CEO
Credential:
Phone: 814-452-7753