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General NPI Number Information
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NPI Number | 1821419813
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Entity Type | Organization
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Legal Business Name | SAINT VINCENT DIABETES RESOURCE OUTPATIENT NUTRITION CENTER
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Dates
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Enumeration Date | 12/18/2013
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Last Update Date | 12/18/2013
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Provider Practice Location Address
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Address Line | 145 W 23RD ST SUITE 302
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City | ERIE
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State | PA
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Zip | 16544-0002
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Country | US
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Telephone | 814-452-7354
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Fax |
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Provider Business Mailing Address
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Address Line | 145 W 23RD ST SUITE 302
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City | ERIE
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State | PA
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Zip | 16544-0002
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Country | US
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Telephone | 814-452-7354
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. SCOTT A WHALEN
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Credential | PHD, FACHE
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Telephone | 814-452-5111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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