Provider Demographics
NPI:1043565021
Name:MERCY DIAGNOSTICS INC
Entity Type:Organization
Organization Name:MERCY DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-437-5249
Mailing Address - Street 1:3109 POPLARWOOD CT
Mailing Address - Street 2:SUITE 302
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1011
Mailing Address - Country:US
Mailing Address - Phone:856-437-5249
Mailing Address - Fax:
Practice Address - Street 1:2040 BRIGGS RD
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-4638
Practice Address - Country:US
Practice Address - Phone:877-514-5504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory