Provider Demographics
NPI: | 1740610450 |
---|---|
Name: | MEDICAL ASSOCIATES OF ERIE |
Entity Type: | Organization |
Organization Name: | MEDICAL ASSOCIATES OF ERIE |
Other - Org Name: | LECOM INSTITUTE FOR SUCCESSFUL AGING |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CHIEF FINANCIAL OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SHELLY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | STEINBECK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 814-868-2535 |
Mailing Address - Street 1: | 1 LECOM PL |
Mailing Address - Street 2: | |
Mailing Address - City: | ERIE |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 16505-2571 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 814-868-2535 |
Mailing Address - Fax: | 814-868-2522 |
Practice Address - Street 1: | 5401 PEACH ST STE 3600 |
Practice Address - Street 2: | |
Practice Address - City: | ERIE |
Practice Address - State: | PA |
Practice Address - Zip Code: | 16509-2601 |
Practice Address - Country: | US |
Practice Address - Phone: | 814-868-7850 |
Practice Address - Fax: | 814-868-2115 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-11-15 |
Last Update Date: | 2013-11-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty |