Provider Demographics
NPI:1497094551
Name:SAINT VINCENT MEDICAL EDUCATION AND RESEARCH INSTITUTE
Entity Type:Organization
Organization Name:SAINT VINCENT MEDICAL EDUCATION AND RESEARCH INSTITUTE
Other - Org Name:SAINT VINCENT ALLIED UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-452-5241
Mailing Address - Street 1:311 W 24TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2665
Mailing Address - Country:US
Mailing Address - Phone:814-452-4214
Mailing Address - Fax:814-459-7823
Practice Address - Street 1:311 W 24TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2665
Practice Address - Country:US
Practice Address - Phone:814-452-4214
Practice Address - Fax:814-459-7823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-11
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA021504Medicare PIN