Provider Demographics
NPI:1861486698
Name:MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA
Entity Type:Organization
Organization Name:MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA
Other - Org Name:MERCY PHILADELPHIA HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:H
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-567-6771
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:610-567-6000
Mailing Address - Fax:610-567-6611
Practice Address - Street 1:501 S 54TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1900
Practice Address - Country:US
Practice Address - Phone:215-748-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-08
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001449OtherAETNA
PA0001023000OtherIBC
PA0001023000OtherKEYSTONE EAST
PA390156OtherMEDICARE ID TYPE UNSPECIFIED
PA08378OtherHEALTH PARTNERS
PA100730682Medicaid
PA60002OtherKMHP
PA76233301OtherAMERICHOICE