Basic Information
| Provider Information | |||||||||
| NPI: | 1982784658 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT VINCENT MEDICAL EDUCATION AND RESEARCH INSTITUTE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LIBERTY FAMILY PRACTICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 153 E 13TH ST STE 1300 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165031035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144525772 | ||||||||
| FaxNumber: | 8144527005 | ||||||||
| Practice Location | |||||||||
| Address1: | 3413 CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165082678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148689828 | ||||||||
| FaxNumber: | 8148688561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 09/28/2018 | ||||||||
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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 | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.