Basic Information
| Provider Information | |||||||||
| NPI: | 1306935143 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERCY PRIMARY CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 680 ANDERSEN DRIVE | ||||||||
| Address2: | MED 3000 ATTN SCOTT MADDEN | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152202759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129378887 | ||||||||
| FaxNumber: | 4129379221 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 LOCUST ST | ||||||||
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| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152195114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129378887 | ||||||||
| FaxNumber: | 4129379221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 02/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | LANG | ||||||||
| AuthorizedOfficialFirstName: | STACEY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 4122327545 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 2084N0400X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1551082 | 01 | PA | GATEWAY HEALTH PLANS | OTHER | 15821240088 | 05 | PA | MEDICAID | 1800680 | 01 | PA | HIGHMARK BSPA | OTHER | 20047086 | 01 | PA | AMERIHEALTH MERCY | OTHER | 422294 | 01 | PA | HEALTH AMERICA | OTHER | 498760 | 01 | PA | AETNA | OTHER | 000000176465 | 01 | PA | UNISON | OTHER | 422297 | 01 | PA | HEALTH ASSURANCE | OTHER | 422297 | 01 | PA | ADVANTRA FREEDOM | OTHER | CC4486 | 01 | PA | RR MEDICARE | OTHER |