| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2928 Peach St, Erie, Pennsylvania |
| Authorized Official Name and Position | Patricia J Stubber (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8144536229 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2928 Peach St Erie PA 16508-1843 Ph: (814) 453-6229 | 2928 Peach St Erie PA 16508-1843 Ph: (814) 453-6229 |
| NPI Number | 1730227307 |
|---|---|
| Provider Enumeration Date | 02/03/2007 |
| Last Update Date | 09/02/2020 |
| Medicare PECOS PAC ID | 9537299730 |
|---|---|
| Medicare Enrollment ID | O20100615000504 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730227307 | NPI | - | NPPES |
| 0011041350002 | Medicaid | PA | |
| 1026455800002 | Medicaid | PA | |
| 0011041350006 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Anthony M Ruffa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134128341 PECOS PAC ID: 6709894397 Enrollment ID: I20060323000228 |
| Provider Name | Richard E Hulse |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1184782559 PECOS PAC ID: 2062584279 Enrollment ID: I20080703000356 |
| Provider Name | Ross A Snow |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609833573 PECOS PAC ID: 8729067509 Enrollment ID: I20090211000028 |
| Provider Name | Shabia Singh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326499294 PECOS PAC ID: 7517252380 Enrollment ID: I20191107002953 |
| Provider Name | Cara Ferguson Moutsos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033786892 PECOS PAC ID: 6002217163 Enrollment ID: I20210625002625 |
| Provider Name | Victoria A Hulse |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1326613233 PECOS PAC ID: 6709289382 Enrollment ID: I20210720001148 |
| Provider Name | Vadim Kovalevich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477221752 PECOS PAC ID: 2961893904 Enrollment ID: I20211229001371 |
| Provider Name | Olga Dyachkina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659135473 PECOS PAC ID: 2961843891 Enrollment ID: I20240509002643 |
| Provider Name | Kristin Mcqueeney |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1508219098 PECOS PAC ID: 1254663198 Enrollment ID: I20240911003562 |
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