Provider Demographics
NPI:1275812182
Name:MERCY HOSPITAL MEDICAL CENTRE
Entity Type:Organization
Organization Name:MERCY HOSPITAL MEDICAL CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VIDHYALAKSHMY
Authorized Official - Middle Name:
Authorized Official - Last Name:VIVEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-647-5708
Mailing Address - Street 1:345 E EASTGATE PL
Mailing Address - Street 2:APT 205
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-5504
Mailing Address - Country:US
Mailing Address - Phone:732-647-5708
Mailing Address - Fax:
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:MERCY HOSPITAL MEDICAL CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-567-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125059101284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital