Provider Demographics
NPI:1437130705
Name:MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA
Entity Type:Organization
Organization Name:MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HILKER
Authorized Official - Suffix:
Authorized Official - Credentials:
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 1:1503 LANSDOWNE AVENUE
Practice Address - Street 2:SUITE 2000
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1900
Practice Address - Country:US
Practice Address - Phone:610-237-3646
Practice Address - Fax:610-237-4261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA025024OtherHEALTHPARTNERS
PA30001873OtherKMHP
PAG0006731OtherAMERICHOICE
PA372921OtherHIGHMARK BLUE SHIELD
PA0114720000OtherKHPE
PAG0007408OtherAMERICHOICE
PA025024OtherHEALTHPARTNERS
PA372921OtherHIGHMARK BLUE SHIELD
PAG0007408OtherAMERICHOICE
PA30001873OtherKMHP
PA1007306820041Medicaid
PACG0988Medicare PIN