Provider Demographics
NPI:1649405796
Name:ST VINCENT MEDICAL EDUCATION AND RESEARCH INSTITUTE INC
Entity Type:Organization
Organization Name:ST VINCENT MEDICAL EDUCATION AND RESEARCH INSTITUTE INC
Other - Org Name:SAINT VINCENT URGENT CARE EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:814-452-5296
Mailing Address - Street 1:3530 PEACH ST
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2768
Mailing Address - Country:US
Mailing Address - Phone:814-860-5000
Mailing Address - Fax:814-860-5050
Practice Address - Street 1:4950 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-2304
Practice Address - Country:US
Practice Address - Phone:814-899-7000
Practice Address - Fax:814-899-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100772520Medicaid
PA021504Medicare PIN