Basic Information
| Provider Information | |||||||||
| NPI: | 1295064467 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MERCY HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6140 E COLUMBIA ST | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477159133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124751948 | ||||||||
| FaxNumber: | 8124011267 | ||||||||
| Practice Location | |||||||||
| Address1: | 4411 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477140890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124751948 | ||||||||
| FaxNumber: | 8124011267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2009 | ||||||||
| LastUpdateDate: | 12/16/2009 | ||||||||
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| AuthorizedOfficialLastName: | HADAD | ||||||||
| AuthorizedOfficialFirstName: | LOTFI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8124751948 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251F00000X | N | Agencies | Home Infusion | 251G00000X | N | Agencies | Hospice Care, Community Based | 251E00000X | Y | Agencies | Home Health |
No ID Information.