Provider Demographics
NPI:1396962973
Name:MERCY A. HALVERSON
Entity type:Organization
Organization Name:MERCY A. HALVERSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HALVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-456-2334
Mailing Address - Street 1:1817 N HELM AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1631
Mailing Address - Country:US
Mailing Address - Phone:559-456-2334
Mailing Address - Fax:559-456-2336
Practice Address - Street 1:1817 N HELM AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1631
Practice Address - Country:US
Practice Address - Phone:559-456-2334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ42236ZMedicare PIN