Provider Demographics
NPI:1093132946
Name:MERCY HOSPITAL
Entity Type:Organization
Organization Name:MERCY HOSPITAL
Other - Org Name:MERCY FORE RIVER EXPRESS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REIMBURSEMENT TECH
Authorized Official - Prefix:MISS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HUCK
Authorized Official - Suffix:
Authorized Official - Credentials:CPAT
Authorized Official - Phone:207-831-5995
Mailing Address - Street 1:175 FORE RIVER PKWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2779
Mailing Address - Country:US
Mailing Address - Phone:207-553-6105
Mailing Address - Fax:207-553-6168
Practice Address - Street 1:175 FORE RIVER PKWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2779
Practice Address - Country:US
Practice Address - Phone:207-553-6105
Practice Address - Fax:207-553-6168
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME37636282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME20008Medicare UPIN