Provider Demographics
NPI:1336376854
Name:MERCY CARE
Entity Type:Organization
Organization Name:MERCY CARE
Other - Org Name:MERCY CARE-PALLIATIVE CARE PARTNERS
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:FAUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-848-6480
Mailing Address - Street 1:8216 DEVON CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4178
Mailing Address - Country:US
Mailing Address - Phone:843-848-6480
Mailing Address - Fax:843-848-6655
Practice Address - Street 1:8216 DEVON CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4178
Practice Address - Country:US
Practice Address - Phone:843-848-6480
Practice Address - Fax:843-848-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHPC-00531041C0700X, 207Q00000X, 207R00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC000000191785OtherBLUECROSS BLUESHIELD OF SC CREDENTIALING FOR PALLIATIVE CARE VISITS
SCGP5545Medicaid
SC8244OtherOLD, DEACTIVATED MEDICARE B PTAN (PRIOR TO 2009)
SCDQ8026OtherMEDICARE RAILROAD
SC000000191785OtherBLUECROSS BLUESHIELD OF SC CREDENTIALING FOR PALLIATIVE CARE VISITS