Provider Demographics
NPI:1164463428
Name:MERCY SUBURBAN HOSPITAL
Entity Type:Organization
Organization Name:MERCY SUBURBAN HOSPITAL
Other - Org Name:MERCY SUBURBAN IP PSYCH UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
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:619-567-6000
Mailing Address - Fax:
Practice Address - Street 1:2701 DEKALB PIKE
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-1820
Practice Address - Country:US
Practice Address - Phone:610-278-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH SYSTEM OF SOUTHEASTERN PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-09
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007277020007OtherMEDICAL ASSISTANCE
PA1108OtherBLUE CROSS
PA111187OtherHRM
PA1333OtherUSHC MEDICARE
PA56OtherELDERHEALTH
PAX000404301OtherAMERICHOICE MEDICARE
PA08300OtherSENIOR PARTNERS
PAX000404301OtherAMERICHOICE
PA0001108000OtherMAGELLAN
PA08300OtherHEALTHPARTNERS
PA1007277020018OtherMEDICAL ASSISTANCE
PA00000000OtherCBH
PA0001108000OtherKEYCARE
PA1Y0133OtherPHS
PA31067OtherKMHP
PA70006OtherKMHP
PA100136OtherKMHP
PA1Y0133OtherPHS