Provider Demographics
NPI:1083965404
Name:MERCY PHYSICIAN NETWORK
Entity Type:Organization
Organization Name:MERCY PHYSICIAN NETWORK
Other - Org Name:MERCY GRAYLING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAYLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:989-366-2900
Mailing Address - Street 1:2585 W HOUGHTON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PRUDENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48651-9624
Mailing Address - Country:US
Mailing Address - Phone:989-366-2900
Mailing Address - Fax:989-366-1166
Practice Address - Street 1:2585 W HOUGHTON LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:PRUDENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48651
Practice Address - Country:US
Practice Address - Phone:989-366-2900
Practice Address - Fax:989-366-1166
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704226766261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIBOYSCOUT2OtherNPI 1942519525