Provider Demographics
NPI:1346686896
Name:MERCY MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:MERCY MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:N
Authorized Official - Last Name:FODJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-462-7165
Mailing Address - Street 1:308 TOLBELT CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7599
Mailing Address - Country:US
Mailing Address - Phone:540-657-9037
Mailing Address - Fax:
Practice Address - Street 1:308 TOLBELT CT
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7599
Practice Address - Country:US
Practice Address - Phone:540-657-9037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332H00000XSuppliersEyewear Supplier