1902105976 NPI number — MERCY HOSPICE LLC

Table of content: BENJAMIN MIRANDA RIVERA MD (NPI 1548325947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902105976 NPI number — MERCY HOSPICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY HOSPICE LLC
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:
6
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:
1902105976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAPHNE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36526-2130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-652-6167
Provider Business Mailing Address Fax Number:
205-652-9110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 STARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STARKVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39759-3556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-338-0007
Provider Business Practice Location Address Fax Number:
662-338-0025
Provider Enumeration Date:
03/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BLAIR
Authorized Official First Name:
LEWIS
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
205-652-6167

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  151 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 05677023 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com