Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 650 East Ave, Erie, Pennsylvania |
Authorized Official Name and Position | Carl A Sizer (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 7243420126 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
63 Pitt St Sharon PA 16146-2102 Ph: (724) 342-3002 | 650 East Ave Erie PA 16503-1524 Ph: (814) 877-8030 |
NPI Number | 1649676511 |
---|---|
Provider Enumeration Date | 11/05/2014 |
Last Update Date | 07/11/2024 |
Medicare PECOS PAC ID | 9234046228 |
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Medicare Enrollment ID | O20150121001228 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649676511 | NPI | - | NPPES |
1007578460114 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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