Provider Demographics
NPI:1831264308
Name:SAINT VINCENT AFFILIATED PHYSICIANS
Entity type:Organization
Organization Name:SAINT VINCENT AFFILIATED PHYSICIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-838-3405
Mailing Address - Street 1:3822 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-3826
Mailing Address - Country:US
Mailing Address - Phone:814-833-5653
Mailing Address - Fax:814-838-1153
Practice Address - Street 1:3822 COLONIAL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-3826
Practice Address - Country:US
Practice Address - Phone:814-833-5653
Practice Address - Fax:814-838-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001785895OtherHIGHMARK
DE2353OtherRR
PA408712OtherHEALTHAMERICA
097981Medicare PIN