Provider Demographics
NPI:1922365014
Name:WEXFORD MERCY PHO
Entity Type:Organization
Organization Name:WEXFORD MERCY PHO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL OPERATIONS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:OBERHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MBA, PMP
Authorized Official - Phone:231-876-7362
Mailing Address - Street 1:117 N MITCHELL ST
Mailing Address - Street 2:STE. 6
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-1884
Mailing Address - Country:US
Mailing Address - Phone:231-876-7139
Mailing Address - Fax:231-775-4187
Practice Address - Street 1:117 N MITCHELL ST
Practice Address - Street 2:STE. 6
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-1884
Practice Address - Country:US
Practice Address - Phone:231-876-7139
Practice Address - Fax:231-775-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management