Provider Demographics
NPI:1548343411
Name:ERIE PHYSICIANS NETWORK PC
Entity type:Organization
Organization Name:ERIE PHYSICIANS NETWORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIANS & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:M
Authorized Official - Last Name:CACCHIONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-456-5469
Mailing Address - Street 1:3535 PINE AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-1743
Mailing Address - Country:US
Mailing Address - Phone:814-456-5469
Mailing Address - Fax:814-453-2698
Practice Address - Street 1:1325 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1469
Practice Address - Country:US
Practice Address - Phone:814-452-4022
Practice Address - Fax:814-452-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5590800001Medicare NSC