Provider Demographics
NPI:1942248828
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 - PSYCHIATRIC
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:610-567-6633
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:2006-06-03
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007306820048OtherCBH
PA1007306820070OtherCBH
PA117234OtherHRM
PA08378OtherHEALTHPARTNERS
PA1007306820048OtherMEDICAL ASSISTANCE
PA1007306820097OtherMEDICAL ASSISTANCE
PA0001023000OtherMAGELLAN
PA0001023000OtherKEYCARE
PA1007306820043OtherMEDICAL ASSISTANCE
PA39S156OtherMEDICARE ID TYPE UNSPECIFIED
PA1007306820068OtherMEDICAL ASSISTANCE
PA24OtherELDERHEALTH
PA76233302OtherAMERICHOICE
PA10073068200861OtherCBH
PA1007306820090OtherMEDICAL ASSISTANCE
PAPA111OtherQUALMED
PA60002OtherKMHP
PA76233301OtherAMERICHOICE
PA1007306820090OtherMEDICAL ASSISTANCE