Provider Demographics
NPI:1134417983
Name:MERCY HOSPITAL AND MEDICAL CENTER
Entity type:Organization
Organization Name:MERCY HOSPITAL AND MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-567-6691
Mailing Address - Street 1:1212 S MICHIGAN AVE
Mailing Address - Street 2:UNIT # 2502
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1212 S MICHIGAN AVE
Practice Address - Street 2:UNIT 2502
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2416
Practice Address - Country:US
Practice Address - Phone:305-962-2911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125060554282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital