Provider Demographics
NPI:1528406808
Name:MERCY HOSPITAL
Entity Type:Organization
Organization Name:MERCY HOSPITAL
Other - Org Name:MERCY EXPRESS CARE GORHAM CROSSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DELEGATED MEDICARE OFFICIAL
Authorized Official - Prefix:MISS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HUCK
Authorized Official - Suffix:
Authorized Official - Credentials:CPAT
Authorized Official - Phone:207-879-3155
Mailing Address - Street 1:144 STATE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3776
Mailing Address - Country:US
Mailing Address - Phone:207-879-3000
Mailing Address - Fax:
Practice Address - Street 1:19 SOUTH GORHAM CROSSING
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1912
Practice Address - Country:US
Practice Address - Phone:207-535-1400
Practice Address - Fax:207-839-8006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-10
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME37636282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
200008Medicare UPIN