Provider Demographics
NPI:1952033011
Name:MERCY HEALTH CARE AND CLINIC
Entity Type:Organization
Organization Name:MERCY HEALTH CARE AND CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHINYENUM
Authorized Official - Middle Name:
Authorized Official - Last Name:OTUYA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:240-476-3951
Mailing Address - Street 1:1400 MERCANTILE LN STE 204
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5352
Mailing Address - Country:US
Mailing Address - Phone:240-476-3951
Mailing Address - Fax:
Practice Address - Street 1:1400 MERCANTILE LN STE 204
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5352
Practice Address - Country:US
Practice Address - Phone:240-476-3951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty