Basic Information
| Provider Information | |||||||||
| NPI: | 1710117494 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT VINCENT MEDICAL EDUCATION AND RESEARCH INSTITUTE INC | ||||||||
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| OtherOrganizationName: | AHN HEALTH & WELLNESS PAVILION URGENT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1910 SASSAFRAS ST | ||||||||
| Address2: | STE 100 | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165022716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144525772 | ||||||||
| FaxNumber: | 8144527005 | ||||||||
| Practice Location | |||||||||
| Address1: | 4247 W RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165061746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148382468 | ||||||||
| FaxNumber: | 8148352599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2009 | ||||||||
| LastUpdateDate: | 04/01/2016 | ||||||||
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| AuthorizedOfficialLastName: | MURPHY | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8144525216 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1007725200054 | 05 | PA | MEDICAID |