Provider Demographics
NPI:1558783548
Name:MERCY MEDICAL CENTER
Entity Type:Organization
Organization Name:MERCY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-332-9808
Mailing Address - Street 1:1421 S CATON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-1025
Mailing Address - Country:US
Mailing Address - Phone:410-368-1370
Mailing Address - Fax:
Practice Address - Street 1:1421 S CATON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1025
Practice Address - Country:US
Practice Address - Phone:410-368-1370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0061347261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407937000Medicaid
MD165L 216639YXTMedicare PIN