Provider Demographics
NPI:1093750473
Name:MERCY OUTPATIENT SERVICES, INC.
Entity Type:Organization
Organization Name:MERCY OUTPATIENT SERVICES, INC.
Other - Org Name:SISTER EMMANUEL HOSPITAL FOR CONTINUING CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHEDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-285-2939
Mailing Address - Street 1:3663 S MIAMI AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4253
Mailing Address - Country:US
Mailing Address - Phone:305-285-2939
Mailing Address - Fax:305-285-5042
Practice Address - Street 1:3663 S MIAMI AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4253
Practice Address - Country:US
Practice Address - Phone:305-285-2939
Practice Address - Fax:305-285-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4474282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-2016Medicare ID - Type UnspecifiedPROVIDER NUMBER