Provider Demographics
NPI:1013350883
Name:MERCY CATHOLIC MEDICAL CTR OF SOUTHEASTERN PA
Entity Type:Organization
Organization Name:MERCY CATHOLIC MEDICAL CTR OF SOUTHEASTERN PA
Other - Org Name:MERCY PHILADELPHIA HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO, SR. VP
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 STE 100
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-4108
Mailing Address - Country:US
Mailing Address - Phone:610-567-6000
Mailing Address - Fax:
Practice Address - Street 1:501 S 54TH STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1916
Practice Address - Country:US
Practice Address - Phone:610-567-6000
Practice Address - Fax:610-271-9371
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY CATHOLIC MEDICAL CTR OF SOUTHEASTERN PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100730682Medicaid