Provider Demographics
NPI:1821075136
Name:MERCY HEALTH PARTNERS
Entity Type:Organization
Organization Name:MERCY HEALTH PARTNERS
Other - Org Name:MERCY HEALTH HEALTHCARE EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:K
Authorized Official - Last Name:NAGENGAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-728-1950
Mailing Address - Street 1:1124 E HACKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1874
Mailing Address - Country:US
Mailing Address - Phone:231-672-4711
Mailing Address - Fax:231-722-2625
Practice Address - Street 1:1124 E HACKLEY AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1874
Practice Address - Country:US
Practice Address - Phone:231-672-4711
Practice Address - Fax:231-722-2625
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HACKLEY HEALTH CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-28
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI382578569332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1640291Medicaid
MI540F102510OtherBLUE CROSS BLUE SHIELD
MI540F102510OtherBLUE CROSS BLUE SHIELD