Provider Demographics
NPI:1942228390
Name:MERCY MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:MERCY MEDICAL CENTER, INC.
Other - Org Name:MERCY MEDICAL CENTER INPATIENT REHABILITATION UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KASBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-677-2458
Mailing Address - Street 1:2700 NW STEWART PKWY
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1281
Mailing Address - Country:US
Mailing Address - Phone:541-677-2458
Mailing Address - Fax:541-677-4830
Practice Address - Street 1:2700 NW STEWART PKWY
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1281
Practice Address - Country:US
Practice Address - Phone:541-677-2458
Practice Address - Fax:541-677-4830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR141133273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR38-T027Medicare ID - Type UnspecifiedMEDICARE SUBPROVIDER NO.