1174587067 NPI number — MERCY MEDICAL, A CORPORATION

Table of content: (NPI 1174587067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174587067 NPI number — MERCY MEDICAL, A CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY MEDICAL, A CORPORATION
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:
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:
1174587067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1090
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:
36526-1090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
374 GREENO RD S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRHOPE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36532-1916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-621-4431
Provider Business Practice Location Address Fax Number:
251-621-4896
Provider Enumeration Date:
04/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BORRONI
Authorized Official First Name:
NECIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
251-459-6454

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  11712 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MER7034A , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017034 . This is a "MEDICARE OSCAR NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51535174 . This is a "BC BS OF AL PROVER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 9245 . This is a "HEALTHSPRING PROVIDER NUM" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51041160 . This is a "BCBS OF AL PROVIDER NUM" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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