MEDICARE: ERIE MEDICAL SPECIALTY CLINIC, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	MD025800E	PA

General Provider Information

NPI Number	:	1184656944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERIE MEDICAL SPECIALTY CLINIC, PC

Provider Business Mailing Address
First Line	:	2566 W 12TH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-4508
Country	:	US
Telephone Number	:	814-838-0990
Fax Number	:

Provider Business Practice Location Address
First Line	:	2566 W 12TH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-4508
Country	:	US
Telephone Number	:	814-838-0990
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN LYONS
Credential	:
Telephone Number	:	814-455-2170

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	08/22/2020

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