Basic Information
| Provider Information | |||||||||
| NPI: | 1679667836 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERCY HOSPITAL OKLAHOMA CITY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4300 W MEMORIAL RD | ||||||||
| Address2: | ATTN: JON VITIELLO | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731208304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057253724 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4300 W MEMORIAL RD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731208304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057551515 | ||||||||
| FaxNumber: | 4057523811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 06/08/2012 | ||||||||
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| AuthorizedOfficialLastName: | VITIELLO | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4057523724 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MERCY HOSPITAL OKLAHOMA CITY, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | Y | Hospital Units | Rehabilitation Unit |
ID Information
| ID | Type | State | Issuer | Description | 000370013-001 | 01 | OK | BC/BS # - ACUTE & REHAB | OTHER |