Provider Demographics
NPI:1275701161
Name:MERCY PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:MERCY PROFESSIONAL SERVICES
Other - Org Name:MERCY OB/GYN PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-876-7200
Mailing Address - Street 1:PO BOX 533
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738
Mailing Address - Country:US
Mailing Address - Phone:989-348-0054
Mailing Address - Fax:
Practice Address - Street 1:7985 MACKINAW TRL STE 201
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8111
Practice Address - Country:US
Practice Address - Phone:231-779-5277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HOSPITAL CADILLAC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-14
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty