1346285376 NPI number — MERCY MANAGEMENT OF SE PA

Table of content: (NPI 1346285376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346285376 NPI number — MERCY MANAGEMENT OF SE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY MANAGEMENT OF SE PA
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 FITZGERALD CRNA SERVICES
Provider Other Organization Name Type Code:
3
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:
1346285376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 827675
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19182-7675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-423-7700
Provider Business Mailing Address Fax Number:
856-423-0823

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 LANSDOWNE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DARBY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-237-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAMERON
Authorized Official First Name:
GINA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DELEGATED OFFICIAL
Authorized Official Telephone Number:
610-237-4280

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007787930164 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DB6047 . This is a "RAILROAD MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".




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