1396857504 NPI number — MERCY MANAGEMENT OF SEPA

Table of content: (NPI 1396857504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396857504 NPI number — MERCY MANAGEMENT OF SEPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY MANAGEMENT OF SEPA
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 ORTHOPEDIC GROUP
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:
1396857504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 W ELM ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CONSHOHOCKEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19428-4108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-567-6967
Provider Business Mailing Address Fax Number:
610-567-6170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
433 S LANSDOWNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YEADON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19050-2405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-626-9800
Provider Business Practice Location Address Fax Number:
610-237-4202
Provider Enumeration Date:
09/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
PATIENT ACCOUNTS VP
Authorized Official Telephone Number:
610-567-6967

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007787930170 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2760128000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1893659 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30035145 . This is a "KEYSTONE MERCY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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