Healthcare Provider Details

I. General information

NPI: 1710117494
Provider Name (Legal Business Name): SAINT VINCENT MEDICAL EDUCATION AND RESEARCH INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4247 W RIDGE RD
ERIE PA
16506-1746
US

IV. Provider business mailing address

1910 SASSAFRAS ST STE 100
ERIE PA
16502-2716
US

V. Phone/Fax

Practice location:
  • Phone: 814-838-2468
  • Fax: 814-835-2599
Mailing address:
  • Phone: 814-452-5772
  • Fax: 814-452-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS MURPHY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 814-452-5216