Provider Demographics
NPI:1629062906
Name:THE MERCY HOSPITAL INC
Entity Type:Organization
Organization Name:THE MERCY HOSPITAL INC
Other - Org Name:PROVIDENCE BEHAVIORAL HEALTH HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-714-4396
Mailing Address - Street 1:1233 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-5381
Mailing Address - Country:US
Mailing Address - Phone:413-536-5111
Mailing Address - Fax:
Practice Address - Street 1:1233 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040
Practice Address - Country:US
Practice Address - Phone:413-536-5111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA628273R00000X, 283Q00000X
MA35282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No273R00000XHospital UnitsPsychiatric Unit
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110027346FMedicaid
MA110027346CMedicaid
MA110027346DMedicaid
FL9105905Medicaid
MA2222002305OtherBLUE CROSS OF MASS INPT
MA2222002330OtherBLUE CROSS OF MASS OP SUR
CT3032125Medicaid
MA2222002325OtherBLUE CROSS OF MASS OUTPT
MA2222002325OtherBLUE CROSS OF MASS OUTPT
CT3032125Medicaid
MA220066Medicare Oscar/Certification