Provider Demographics
NPI:1003070871
Name:ERIE SLEEP & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:ERIE SLEEP & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-455-1500
Mailing Address - Street 1:240 W 11TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1758
Mailing Address - Country:US
Mailing Address - Phone:814-455-1500
Mailing Address - Fax:814-455-3109
Practice Address - Street 1:240 W 11TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1758
Practice Address - Country:US
Practice Address - Phone:814-455-1500
Practice Address - Fax:814-455-3109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102289832 0001Medicaid
PA141239Medicare PIN
PA102289832 0001Medicaid