1073883161 NPI number — MERCY LIFE CENTER CORP

Table of content: (NPI 1073883161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073883161 NPI number — MERCY LIFE CENTER CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY LIFE CENTER CORP
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:
1073883161
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 REEDSDALE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15233-2109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-697-0712
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
249 SOUTH 9TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-697-3260
Provider Business Practice Location Address Fax Number:
412-697-3263
Provider Enumeration Date:
01/05/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ANGLUM
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
PATIENT ACCOUNTING MANAGER
Authorized Official Telephone Number:
412-697-0712

Provider Taxonomy Codes

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

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

  • Identifier: 165912 . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1604175 . This is a "GATEWAY HEALTH PLANS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2684111 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".