Provider Demographics
NPI:1568739167
Name:MERCY MEDICAL & WEIGHT LOSS CENTER, INC.
Entity Type:Organization
Organization Name:MERCY MEDICAL & WEIGHT LOSS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOVITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANYANWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-401-5757
Mailing Address - Street 1:187 S SCHUYLER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3831
Mailing Address - Country:US
Mailing Address - Phone:815-401-5757
Mailing Address - Fax:
Practice Address - Street 1:187 S SCHUYLER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3831
Practice Address - Country:US
Practice Address - Phone:815-401-5757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-27
Last Update Date:2011-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty