Provider Demographics
NPI:1649208802
Name:MERCY MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:MERCY MEDICAL CENTER, INC.
Other - Org Name:MERCY MEDICAL CENTER HOSPICE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-677-2466
Mailing Address - Street 1:2675 NW EDENBOWER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-6201
Mailing Address - Country:US
Mailing Address - Phone:541-677-2384
Mailing Address - Fax:541-677-2498
Practice Address - Street 1:2675 NW EDENBOWER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-6201
Practice Address - Country:US
Practice Address - Phone:541-677-2384
Practice Address - Fax:541-677-2498
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-28
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR141133251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR132022Medicaid
OR38-1521Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER