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General NPI Number Information
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NPI Number | 1184656944
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Entity Type | Organization
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Legal Business Name | ERIE MEDICAL SPECIALTY CLINIC, PC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2566 W 12TH ST
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City | ERIE
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State | PA
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Zip | 16505-4508
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Country | US
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Telephone | 814-838-0990
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Fax |
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Provider Business Mailing Address
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Address Line | 2566 W 12TH ST
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City | ERIE
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State | PA
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Zip | 16505-4508
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Country | US
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Telephone | 814-838-0990
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN LYONS
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Credential |
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Telephone | 814-455-2170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | MD025800E
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License Number State | PA
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