Basic Information
| Provider Information | |||||||||
| NPI: | 1215931266 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICOR ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 E 2ND ST | ||||||||
| Address2: | STE 2 | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165071537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144568980 | ||||||||
| FaxNumber: | 8144510443 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 E 2ND ST | ||||||||
| Address2: | STE 2 | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165071537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144568980 | ||||||||
| FaxNumber: | 8144510443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2005 | ||||||||
| LastUpdateDate: | 04/06/2009 | ||||||||
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| AuthorizedOfficialLastName: | FURR | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CORPORATION PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8144568980 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | CARDIOLOGY | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 000688380 | 05 | PA | MEDICAID |