Provider Demographics
NPI:1568942845
Name:ST MARY MERCY PHYSICIAN PRACTICES
Entity Type:Organization
Organization Name:ST MARY MERCY PHYSICIAN PRACTICES
Other - Org Name:ST. JOE'S URGENT CARE - LIVONIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR REVENUE MANGEMENT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-343-0282
Mailing Address - Street 1:14555 LEVAN RD STE 310
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5085
Mailing Address - Country:US
Mailing Address - Phone:734-655-2989
Mailing Address - Fax:734-655-8590
Practice Address - Street 1:39201 7 MILE RD RM 140
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1079
Practice Address - Country:US
Practice Address - Phone:734-743-4430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care