Provider Demographics
NPI:1720257751
Name:ERIE PHYSICIANS NETWORK, PC
Entity Type:Organization
Organization Name:ERIE PHYSICIANS NETWORK, PC
Other - Org Name:EPN SLEEP LAB CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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 1:1325 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1469
Mailing Address - Country:US
Mailing Address - Phone:814-456-3259
Mailing Address - Fax:814-452-4437
Practice Address - Street 1:1325 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1469
Practice Address - Country:US
Practice Address - Phone:814-456-3259
Practice Address - Fax:814-452-4437
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERIE PHYSICIANS NETWORK, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1753293OtherHIGHMARK KHPW
PA050648Medicare PIN