Provider Demographics
NPI:1982632311
Name:SAINT VINCENT HEALTH CENTER
Entity Type:Organization
Organization Name:SAINT VINCENT HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-452-5111
Mailing Address - Street 1:232 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16544-0002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:232 W 25TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16544-0002
Practice Address - Country:US
Practice Address - Phone:814-452-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT VINCENT HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-28
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA196001273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0965OtherHIGHMARK FACILITY NUMBER
PA1001625200033Medicaid
PA39T009Medicare ID - Type UnspecifiedPROVIDER NUMBER