MEDICARE: SAINT VINCENT MEDICAL EDUCATION AND RESEARCH INSTITUTE

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1558462259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT VINCENT MEDICAL EDUCATION AND RESEARCH INSTITUTE

Provider Business Mailing Address
First Line	:	3530 PEACH ST
Second Line	:	SUITE LL1
City	:	ERIE
State	:	PA
Zip	:	16508-2768
Country	:	US
Telephone Number	:	814-860-5036
Fax Number	:	814-860-5063

Provider Business Practice Location Address
First Line	:	155 E STATE ST
Second Line	:
City	:	ALBION
State	:	PA
Zip	:	16401-1347
Country	:	US
Telephone Number	:	814-756-4917
Fax Number	:	814-756-5226

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	PATRICIA BALLMAN
Credential	:
Telephone Number	:	814-452-5296

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	11/02/2010

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