Provider Demographics
NPI:1821089848
Name:MERCY SUBURBAN HOSPITAL
Entity Type:Organization
Organization Name:MERCY SUBURBAN HOSPITAL
Other - Org Name:MERCY SUBURBAN FAMILY PRACTICE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P., PAT. FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-567-6967
Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2007
Mailing Address - Country:US
Mailing Address - Phone:610-567-6967
Mailing Address - Fax:610-567-6170
Practice Address - Street 1:530 CHURCH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-4811
Practice Address - Country:US
Practice Address - Phone:610-275-7240
Practice Address - Fax:610-275-1381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100136OtherKMHP
PA202259700OtherOWCP
PA594466OtherHIGHMARK BLUE SHIELD
PAX0004043 01OtherAMERICHOICE
PA85753OtherAUSHC CAP NUMBER
PA0222562002OtherKEYSTONE HEALTHPLAN EAST
PA1007277020017Medicaid
PA594466OtherHIGHMARK BLUE SHIELD