Provider Demographics
NPI:1699202390
Name:SAINT VINCENT MEDICAL EDUCATION AND RESEARCH INST. INC.
Entity Type:Organization
Organization Name:SAINT VINCENT MEDICAL EDUCATION AND RESEARCH INST. INC.
Other - Org Name:GLENWOOD FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-452-5310
Mailing Address - Street 1:1910 SASSAFRAS ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2716
Mailing Address - Country:US
Mailing Address - Phone:814-864-4987
Mailing Address - Fax:814-866-1130
Practice Address - Street 1:213 E 41ST ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-2009
Practice Address - Country:US
Practice Address - Phone:814-864-4987
Practice Address - Fax:814-866-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty