1275812182 NPI number — MERCY HOSPITAL MEDICAL CENTRE

Table of content: (NPI 1275812182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275812182 NPI number — MERCY HOSPITAL MEDICAL CENTRE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY HOSPITAL MEDICAL CENTRE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275812182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
345 E EASTGATE PL
Provider Second Line Business Mailing Address:
APT 205
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60616-5504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-647-5708
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 S MICHIGAN AVE
Provider Second Line Business Practice Location Address:
MERCY HOSPITAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60616-2333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-567-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VIVEK
Authorized Official First Name:
VIDHYALAKSHMY
Authorized Official Middle Name:
Authorized Official Title or Position:
RESIDENT PHYSICIAN
Authorized Official Telephone Number:
732-647-5708

Provider Taxonomy Codes

  • Taxonomy code: 284300000X , with the licence number:  125059101 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)