Provider Demographics
NPI:1972270569
Name:LECOM AT PRESQUE ISLE INC
Entity Type:Organization
Organization Name:LECOM AT PRESQUE ISLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-881-5234
Mailing Address - Street 1:5535 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-2603
Mailing Address - Country:US
Mailing Address - Phone:814-868-2496
Mailing Address - Fax:814-868-2481
Practice Address - Street 1:4114 SCHAPER AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-3350
Practice Address - Country:US
Practice Address - Phone:814-868-0831
Practice Address - Fax:814-868-3566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal DialysisGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030723650001Medicaid