1821089848 NPI number — MERCY SUBURBAN HOSPITAL

Table of content: (NPI 1821089848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821089848 NPI number — MERCY SUBURBAN HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY SUBURBAN HOSPITAL
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 SUBURBAN FAMILY PRACTICE CENTER
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:
1821089848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2010
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:
19428-2007
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:
530 CHURCH ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
NORRISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19401-4811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-275-7240
Provider Business Practice Location Address Fax Number:
610-275-1381
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
C
Authorized Official Title or Position:
V.P., PAT. FINANCIAL SERVICES
Authorized Official Telephone Number:
610-567-6967

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QE0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100136 . This is a "KMHP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 202259700 . This is a "OWCP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 594466 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: X0004043 01 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 85753 . This is a "AUSHC CAP NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0222562002 . This is a "KEYSTONE HEALTHPLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007277020017 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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