Provider Demographics
NPI:1467496711
Name:MERCY HOSPITAL - MUSKEGON SMHC
Entity Type:Organization
Organization Name:MERCY HOSPITAL - MUSKEGON SMHC
Other - Org Name:MHP - MERCY CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER - CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-643-3500
Mailing Address - Street 1:1820 44TH ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5006
Mailing Address - Country:US
Mailing Address - Phone:616-643-3500
Mailing Address - Fax:616-643-3659
Practice Address - Street 1:1500 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1849
Practice Address - Country:US
Practice Address - Phone:616-643-3500
Practice Address - Fax:616-643-3659
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HOSPITAL - MUSKEGON SMHC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI610020273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2982630Medicaid
MI2982630Medicaid