Basic Information
| Provider Information | |||||||||
| NPI: | 1881859502 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HALL-MERCER CMH-MRH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 MARKET ST | ||||||||
| Address2: | UPPER MEZZANINE 600 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191022100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157620630 | ||||||||
| FaxNumber: | 2157620754 | ||||||||
| Practice Location | |||||||||
| Address1: | 245 S 8TH ST | ||||||||
| Address2: | |||||||||
| City: | PHILA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191063520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157620630 | ||||||||
| FaxNumber: | 2157620754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2008 | ||||||||
| LastUpdateDate: | 07/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | MCCORMICK | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSOCIATE VICE PRESIDENT OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 2157620888 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
ID Information
| ID | Type | State | Issuer | Description | 1000049150028 | 05 | PA | MEDICAID |