Provider Demographics
NPI:1093753873
Name:MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA
Entity Type:Organization
Organization Name:MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA
Other - Org Name:MERCY FITZGERALD HOSPITAL - PSYCHIATRIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO & SVP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:H
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-567-6771
Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2007
Mailing Address - Country:US
Mailing Address - Phone:610-567-6603
Mailing Address - Fax:610-567-6633
Practice Address - Street 1:1500 LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1200
Practice Address - Country:US
Practice Address - Phone:610-237-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-03
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001105000OtherMAGELLAN
PA12455OtherHEALTHPARTNERS
PA1007306820001OtherMEDICAL ASSISTANCE
PA1007306820076OtherMEDICAL ASSISTANCE
PA1007306820080OtherMEDICAL ASSISTANCE
PA1007306820100OtherMEDICAL ASSISTANCE
PA1007306820130OtherMEDICAL ASSISTANCE
PA1105OtherBLUE CROSS
PA612766-02OtherAMERICHOICE
PA60001OtherKMHP
PA23OtherELDER CARE
PA1007306820080OtherCBH
PA12455OtherSENIOR PARTNERS
PA39S156OtherMEDICARE ID TYPE UNSPECIFIED
PAPA110OtherQUALMED
PA1007306820127OtherMEDICAL ASSISTANCE
PA1007306820002OtherMEDICAL ASSISTANCE
PA612766-03OtherAMERICHOICE