Provider Demographics
NPI:1902844574
Name:ERIE PHYSICIANS NETWORK PC
Entity Type:Organization
Organization Name:ERIE PHYSICIANS NETWORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:M
Authorized Official - Last Name:CACCHIONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-454-3363
Mailing Address - Street 1:3535 PINE AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-1743
Mailing Address - Country:US
Mailing Address - Phone:814-456-5469
Mailing Address - Fax:814-453-2698
Practice Address - Street 1:3535 PINE AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-1743
Practice Address - Country:US
Practice Address - Phone:814-456-5469
Practice Address - Fax:814-453-2698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100746851Medicaid
PA100746851Medicaid