Organization
CLINICAL PRACTICE OF LECOM INSTITUTE FOR SUCCESSFUL LIVING
Active
Organization
CLINICAL PRACTICE OF LECOM INSTITUTE FOR SUCCESSFUL LIVING
Active
Parent organization
MILLCREEK MANOR
Other names
Rural Health Clinic of Wattsburg
Organization subpart
Yes
Provider details
NPI number
Legal business name
MILLCREEK MANOR
Authorized official
JAMES Y LIN DO (PRESIDENT)
(814) 602-7783
Entity
Organization
Contact information
Practice address
9040 WATTSBURG RD, ERIE, PA 16509-6024
(814) 844-2858
Mailing address
5401 PEACH ST STE 3400, ERIE, PA 16509-2601
(814) 868-2200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
01/22/2024
Last updated
01/22/2024
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