1922108679 NPI number — MERCY MEDICAL CENTER INC.

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 1922108679 NPI number — MERCY MEDICAL CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY MEDICAL CENTER INC.
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 MEDICAL CENTER EMPLOYEE ASSISTANCE SERVICEWORKLIFE PROGRAM
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:
1922108679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 NW STEWART PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEBURG
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97471-1281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-677-4836
Provider Business Mailing Address Fax Number:
541-677-6568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2459 NW STEWART PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97471-1596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-677-4836
Provider Business Practice Location Address Fax Number:
541-677-6568
Provider Enumeration Date:
09/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KASBERGER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
VICE PRESIDENT CFO
Authorized Official Telephone Number:
541-677-2458

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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