Organization
MILLCREEK MANOR
Active
Parent organization
LECOM HEALTH
Other names
Millcreek Manor Vaccine Program
Organization subpart
Yes
Provider details
NPI number
Legal business name
LECOM HEALTH
Authorized official
JOSHUA A BEERBOWER (CFO)
(814) 488-4825
Entity
Organization
Contact information
Practice address
5535 PEACH ST, ERIE, PA 16509-2603
(814) 868-2496
(814) 868-2581
Mailing address
5535 PEACH ST, ERIE, PA 16509-2603
(814) 868-2496
(814) 868-2581
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
261Q00000X
Clinic/Center
—
—
333600000X
Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012079290002
—
PA
Enumeration date
07/22/2020
Last updated
06/11/2025
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