Provider Demographics
NPI:1942354915
Name:MERCER HEALTH CENTER, S.C.
Entity Type:Organization
Organization Name:MERCER HEALTH CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:309-582-7259
Mailing Address - Street 1:409 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:IL
Mailing Address - Zip Code:61231-1209
Mailing Address - Country:US
Mailing Address - Phone:309-582-7259
Mailing Address - Fax:309-582-3105
Practice Address - Street 1:409 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:IL
Practice Address - Zip Code:61231-1209
Practice Address - Country:US
Practice Address - Phone:309-582-7259
Practice Address - Fax:309-582-3105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0006627828OtherBC BS IL PROVIDER NUMBER
IL=========001Medicaid
IL0006627828OtherBC BS IL PROVIDER NUMBER
IL=========001Medicaid