Provider Demographics
NPI:1518352939
Name:LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE
Entity Type:Organization
Organization Name:LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FISCAL AFFAIRS/CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:INMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-868-8258
Mailing Address - Street 1:1858 W GRANDVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 W GRANDVIEW BLVD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1029
Practice Address - Country:US
Practice Address - Phone:814-868-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILLCREEK HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-02
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty