Provider Demographics
NPI: | 1548246127 |
---|---|
Name: | MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA |
Entity Type: | Organization |
Organization Name: | MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA |
Other - Org Name: | MMS-MERCY SPECIALTY ASSOCIATES |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VP FINANCIAL SERVICES |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | DOUGLAS |
Authorized Official - Middle Name: | C |
Authorized Official - Last Name: | SMITH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 610-567-6964 |
Mailing Address - Street 1: | 1 W ELM ST |
Mailing Address - Street 2: | 2ND FLOOR |
Mailing Address - City: | CONSHOHOCKEN |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19428-2007 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 610-567-6964 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 501 S 54TH ST |
Practice Address - Street 2: | SUITE 126 |
Practice Address - City: | PHILADELPHIA |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19143-1900 |
Practice Address - Country: | US |
Practice Address - Phone: | 215-748-9872 |
Practice Address - Fax: | 215-748-9869 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-12-16 |
Last Update Date: | 2017-08-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 36430 | Other | HEALTHPARTNERS |
PA | 1007787930162 | Medicaid | |
PA | 1217362 | Other | AUSHC HMO |
PA | 1761038 | Other | BLUE SHIELD |
PA | 2426698000 | Other | KEYSTONE HEALTH PLAN EAST |
PA | 30031042 | Other | KEYSTONE MERCY HEALTH PLA |
PA | 7479774 | Other | AUSHC PPO |
PA | 2426698000 | Other | KEYSTONE HEALTH PLAN EAST |