Basic Information
| Provider Information | |||||||||
| NPI: | 1184656944 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ERIE MEDICAL SPECIALTY CLINIC, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2566 W 12TH ST | ||||||||
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| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165054508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148380990 | ||||||||
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| Address1: | 2566 W 12TH ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165054508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148380990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LYONS | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8144552170 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0114X | MD025800E | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
No ID Information.