1770569873 NPI number — MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA

Table of content: (NPI 1770569873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770569873 NPI number — MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA
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 PULMONARY ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1770569873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 LANSDOWNE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DARBY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19023-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-567-6964
Provider Business Mailing Address Fax Number:
610-567-6170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 LANSDOWNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DARBY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19023-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-237-5683
Provider Business Practice Location Address Fax Number:
610-567-6955
Provider Enumeration Date:
12/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
VP FINANCIAL SERVICES
Authorized Official Telephone Number:
610-567-6951

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0032979000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1003143 . This is a "KEYSTONE MERCY HEALTH PLA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2805 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 014647 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007787930112 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2805 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 12518890 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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