Basic Information
| Provider Information | |||||||||
| NPI: | 1932422193 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MILLCREEK FAMILY PRACTICE AND INTERNAL MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3530 PEACH ST | ||||||||
| Address2: | SUITE LL1 | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165082768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148605036 | ||||||||
| FaxNumber: | 8148605063 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 W 12TH ST STE C4 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165054527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144616626 | ||||||||
| FaxNumber: | 8148716349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2010 | ||||||||
| LastUpdateDate: | 10/26/2017 | ||||||||
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| AuthorizedOfficialLastName: | LUEBBERT | ||||||||
| AuthorizedOfficialFirstName: | WENDI | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | DELEGATED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 8144525772 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SAINT VINCENT MEDICAL EDUCATION AND RESEARCH INSTITUTE INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.