Provider Demographics
NPI:1851699052
Name:MERCY MEDICAL CENTER MERCED
Entity Type:Organization
Organization Name:MERCY MEDICAL CENTER MERCED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAIK-TESCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-564-3513
Mailing Address - Street 1:4123 TUDAL CT
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-8425
Mailing Address - Country:US
Mailing Address - Phone:209-722-8847
Mailing Address - Fax:
Practice Address - Street 1:4123 TUDAL CT
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-8425
Practice Address - Country:US
Practice Address - Phone:209-722-8847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116159261QB0400X, 261QP2300X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care