Basic Information
| Provider Information | |||||||||
| NPI: | 1386721413 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERCY MEMORIAL HOSPITAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 718 N MACOMB ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342408400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1070 N MONROE ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342408888 | ||||||||
| FaxNumber: | 7342404450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 03/07/2013 | ||||||||
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| AuthorizedOfficialLastName: | SCHILLING | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 7342404520 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MERCY MEMORIAL HOSPITAL CORPORATION | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 580030 | MI | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 540F0380318 | 01 | BLUE CROSS | OTHER | 5171379 | 05 | MI | MEDICAID |