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General NPI Number Information
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NPI Number | 1104906874
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Entity Type | Organization
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Legal Business Name | SAINT VINCENT MEDICAL EDUCATION AND RESEARCH INSTITUTE
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 145 W 23RD ST SUITE 202
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City | ERIE
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State | PA
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Zip | 16502-2858
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Country | US
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Telephone | 814-451-8008
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Fax | 814-456-1528
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Provider Business Mailing Address
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Address Line | 3530 PEACH ST SUITE LL1
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City | ERIE
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State | PA
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Zip | 16508-2768
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Country | US
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Telephone | 814-860-5000
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Fax | 814-860-5050
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DANA BOATMAN
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Credential |
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Telephone | 814-452-5264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number |
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License Number State |
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