Basic Information
| Provider Information | |||||||||
| NPI: | 1235137431 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OUR LADY OF MERCY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 CORPORATE DR | ||||||||
| Address2: | CMO | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107016807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143786163 | ||||||||
| FaxNumber: | 9147090386 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 E 233RD ST | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104662604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189209000 | ||||||||
| FaxNumber: | 9147090386 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 08/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | DOWLING | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR PROVIDER SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 9143774668 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 040403003073 | 01 | NY | FIDELIS PROVIDER NUMBER | OTHER | 000021 | 01 | NY | BLUE CROSS PROVIDER NUMBER | OTHER | 00243563 | 05 | NY | MEDICAID | 000821 | 01 | NY | BLUE CROSS PROVIDER NUMBER | OTHER | HO3109 | 01 | NY | OXFORD PROVIDER NUMBER | OTHER | HO3109A | 01 | NY | OXFORD PROVIDER NUMBER | OTHER |