Provider Demographics
NPI:1982784658
Name:SAINT VINCENT MEDICAL EDUCATION AND RESEARCH INSTITUTE
Entity Type:Organization
Organization Name:SAINT VINCENT MEDICAL EDUCATION AND RESEARCH INSTITUTE
Other - Org Name:LIBERTY FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-452-5216
Mailing Address - Street 1:153 E 13TH ST STE 1300
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16503-1035
Mailing Address - Country:US
Mailing Address - Phone:814-452-5772
Mailing Address - Fax:814-452-7005
Practice Address - Street 1:3413 CHERRY ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2678
Practice Address - Country:US
Practice Address - Phone:814-868-9828
Practice Address - Fax:814-868-8561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
021504Medicare ID - Type Unspecified