Provider Demographics
NPI:1932422193
Name:MILLCREEK FAMILY PRACTICE AND INTERNAL MEDICINE
Entity Type:Organization
Organization Name:MILLCREEK FAMILY PRACTICE AND INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:WENDI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LUEBBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-452-5772
Mailing Address - Street 1:3530 PEACH ST
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2768
Mailing Address - Country:US
Mailing Address - Phone:814-860-5036
Mailing Address - Fax:814-860-5063
Practice Address - Street 1:2501 W 12TH ST STE C4
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4527
Practice Address - Country:US
Practice Address - Phone:814-461-6626
Practice Address - Fax:814-871-6349
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT VINCENT MEDICAL EDUCATION AND RESEARCH INSTITUTE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-02
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty