Provider Demographics
NPI:1225022064
Name:MERCY SUBURBAN HOSPITAL
Entity Type:Organization
Organization Name:MERCY SUBURBAN HOSPITAL
Other - Org Name:
Other - Org Type:
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:ONE WEST ELM ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428
Mailing Address - Country:US
Mailing Address - Phone:610-567-6000
Mailing Address - Fax:610-567-6611
Practice Address - Street 1:2701 DEKALB STREET
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401
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:2005-09-08
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001333OtherAETNA
PA08300OtherHEALTH PARTNERS
PA0001108000OtherKEYSTONE EAST
PAX000404301OtherAMERICHOICE
PA100727702Medicaid
PA70006OtherKMHP
PA0001108000OtherIBC
PA0001108000OtherKEYSTONE EAST