1336376854 NPI number — MERCY CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336376854 NPI number — MERCY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY CARE
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:
MERCY CARE-PALLIATIVE CARE PARTNERS
Provider Other Organization Name Type Code:
5
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:
1336376854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8216 DEVON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MYRTLE BEACH
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29572-4178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-848-6480
Provider Business Mailing Address Fax Number:
843-848-6655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8216 DEVON CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29572-4178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-848-6480
Provider Business Practice Location Address Fax Number:
843-848-6655
Provider Enumeration Date:
06/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
FAUCHER
Authorized Official First Name:
SARA
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
843-848-6480

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  HPC-0053 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: HPC-0053 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: HPC-0053 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: HPC-0053 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000191785 . This is a "BLUECROSS BLUESHIELD OF SC CREDENTIALING FOR PALLIATIVE CARE VISITS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP5545 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8244 . This is a "OLD, DEACTIVATED MEDICARE B PTAN (PRIOR TO 2009)" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: DQ8026 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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