Provider Demographics
NPI:1831189612
Name:MERCY MANAGEMENT OF SEPA
Entity type:Organization
Organization Name:MERCY MANAGEMENT OF SEPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:HALBERSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-567-6964
Mailing Address - Street 1:1 WEST ELM STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19482
Mailing Address - Country:US
Mailing Address - Phone:610-567-6964
Mailing Address - Fax:610-567-6170
Practice Address - Street 1:5630 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3232
Practice Address - Country:US
Practice Address - Phone:215-748-3100
Practice Address - Fax:610-748-1586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADA5351OtherRAILROAD MEDICARE
PA1555770OtherBLUE SHIELD
PA30011129OtherKEYSTONE MERCY HEALTH PLA
PA1007787930163Medicaid
PA18027OtherAETNA HMO
PA2247379000OtherKEYSTONE MERCY HEALTH PLA
PA61258870002OtherCIGNA
PA33699OtherHEALTH PARTNERS
PA5325477OtherAETNA PPO
PA2247379000OtherKEYSTONE MERCY HEALTH PLA