Provider Demographics
NPI:1114236353
Name:MERCY SURGERY CARE NETWORK
Entity Type:Organization
Organization Name:MERCY SURGERY CARE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-985-1868
Mailing Address - Street 1:PO BOX 610669
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48061-0669
Mailing Address - Country:US
Mailing Address - Phone:810-985-1884
Mailing Address - Fax:
Practice Address - Street 1:2609 ELECTRIC AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6589
Practice Address - Country:US
Practice Address - Phone:810-985-1868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011284208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4844446Medicaid
MI4844446Medicaid