1306935143 NPI number — MERCY PRIMARY CARE INC

Table of content: (NPI 1306935143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306935143 NPI number — MERCY PRIMARY CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY PRIMARY CARE 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:
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:
1306935143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
680 ANDERSEN DRIVE
Provider Second Line Business Mailing Address:
MED 3000 ATTN SCOTT MADDEN
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15220-2759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-937-8887
Provider Business Mailing Address Fax Number:
412-937-9221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 LOCUST ST
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:
15219-5114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-937-8887
Provider Business Practice Location Address Fax Number:
412-937-9221
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LANG
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
412-232-7545

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1551082 . This is a "GATEWAY HEALTH PLANS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 15821240088 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1800680 . This is a "HIGHMARK BSPA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20047086 . This is a "AMERIHEALTH MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 422294 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 498760 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000176465 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 422297 . This is a "HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 422297 . This is a "ADVANTRA FREEDOM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CC4486 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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