1457521791 NPI number — MERCY MEDICAL CENTER, INC.

Table of content: (NPI 1457521791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457521791 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:
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:
1457521791
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 ST. PAUL PLACE MERCY MEDICAL CENTER
Provider Second Line Business Mailing Address:
DENTAL DEPT.
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-385-3270
Provider Business Mailing Address Fax Number:
410-545-4253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 ST. PAUL PLACE MERCY MEDICAL CENTER
Provider Second Line Business Practice Location Address:
DENTAL DEPT.
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-332-9262
Provider Business Practice Location Address Fax Number:
410-545-4253
Provider Enumeration Date:
03/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HARPER
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL OFFICE MANAGER
Authorized Official Telephone Number:
410-385-3270

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  4233 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 420804800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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