NPIMap

Organization Active NPI

Lecom MTM Services

  • Research Clinic/Center
  • Erie, PA
National Provider Identifier
1760736870
Registry record updated Oct 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Research Clinic/CenterTaxonomy code 261QR1100X
Legal business name
LECOM MTM SERVICES
Practice address
1858 W Grandview Blvd
Attn.Rebecca Wise-Bayfront Campus
Erie, PA 16509-1025
Phone
(814) 868-2584
Fax
(814) 868-2589
NPI assigned
Oct 29, 2012
Last updated
Oct 29, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Justin Scholl, PHARMD
Title
Manager
Phone
(814) 860-8430

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Research Clinic/Center 261QR1100X Primary

Addresses

Primary practice location

1858 W Grandview Blvd
Attn.Rebecca Wise-Bayfront Campus
Erie, PA 16509-1025

Mailing address

1858 W Grandview Blvd
Attn.Rebecca Wise-Bayfront Campus
Erie, PA 16509-1025
Phone (814) 868-2584

Other names 1

  • LECOM School of Pharmacy Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351468800000",
    "number": "1760736870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1858 W GRANDVIEW BLVD",
            "address_2": "ATTN.REBECCA WISE-BAYFRONT CAMPUS",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165091025",
            "telephone_number": "814-868-2584",
            "fax_number": "814-868-2589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1858 W GRANDVIEW BLVD",
            "address_2": "ATTN.REBECCA WISE-BAYFRONT CAMPUS",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165091025",
            "telephone_number": "814-868-2584",
            "fax_number": "814-868-2589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LECOM MTM SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-29",
        "last_updated": "2012-10-29",
        "status": "A",
        "authorized_official_last_name": "SCHOLL",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "814-860-8430",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "261QR1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Research",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LECOM School of Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.