Provider Demographics
NPI:1396857504
Name:MERCY MANAGEMENT OF SEPA
Entity Type:Organization
Organization Name:MERCY MANAGEMENT OF SEPA
Other - Org Name:MERCY ORTHOPEDIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATIENT ACCOUNTS VP
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:VP
Authorized Official - Phone:610-567-6967
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:19428-4108
Mailing Address - Country:US
Mailing Address - Phone:610-567-6967
Mailing Address - Fax:610-567-6170
Practice Address - Street 1:433 S LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:YEADON
Practice Address - State:PA
Practice Address - Zip Code:19050-2405
Practice Address - Country:US
Practice Address - Phone:610-626-9800
Practice Address - Fax:610-237-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007787930170Medicaid
PA2760128000OtherKEYSTONE HEALTH PLAN EAST
PA1893659OtherHIGHMARK BLUE SHIELD
PA30035145OtherKEYSTONE MERCY HEALTH
PA108873Medicare PIN