Provider Demographics
NPI:1821419813
Name:SAINT VINCENT DIABETES RESOURCE OUTPATIENT NUTRITION CENTER
Entity Type:Organization
Organization Name:SAINT VINCENT DIABETES RESOURCE OUTPATIENT NUTRITION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, FACHE
Authorized Official - Phone:814-452-5111
Mailing Address - Street 1:145 W 23RD ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16544-0002
Mailing Address - Country:US
Mailing Address - Phone:814-452-7354
Mailing Address - Fax:
Practice Address - Street 1:145 W 23RD ST
Practice Address - Street 2:SUITE 302
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16544-0002
Practice Address - Country:US
Practice Address - Phone:814-452-7354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT VINCENT HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0072OtherHIGHMARK FACILITY NUMBER
PA1001625200025Medicaid
390009Medicare PIN