Provider Demographics
NPI:1497065346
Name:MERCY CENTRE FOR FAMILY HEALTH PC
Entity Type:Organization
Organization Name:MERCY CENTRE FOR FAMILY HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GOLDBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-418-5289
Mailing Address - Street 1:PO BOX 090110
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-0110
Mailing Address - Country:US
Mailing Address - Phone:414-247-9005
Mailing Address - Fax:414-247-9004
Practice Address - Street 1:10565 N TATUM BLVD
Practice Address - Street 2:SUITE D-137
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-1095
Practice Address - Country:US
Practice Address - Phone:602-418-5289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty