Provider Demographics
NPI:1689227209
Name:MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANI
Entity Type:Organization
Organization Name:MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANI
Other - Org Name:MERCY SENIOR HEALTH - WEST PHILADELPHIA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-710-2651
Mailing Address - Street 1:41 UNIVERSITY DR STE 106
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5901 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3117
Practice Address - Country:US
Practice Address - Phone:413-262-6762
Practice Address - Fax:610-567-5495
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY ACCOUNTABLE CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-23
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty