Basic Information
| Provider Information | |||||||||
| NPI: | 1942486733 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MERCY HOSPITAL OF PITTSBURGH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 N LINDSAY AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731045410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052715896 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 N LINDSAY AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731045410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052715896 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2008 | ||||||||
| LastUpdateDate: | 06/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | MIRZA | ||||||||
| AuthorizedOfficialFirstName: | LUBNA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | FELLOW | ||||||||
| AuthorizedOfficialTelephone: | 9186450272 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | MT187384 | PA | N | Hospitals | General Acute Care Hospital | Critical Access | 281P00000X | 26232 | OK | Y | Hospitals | Chronic Disease Hospital |
ID Information
| ID | Type | State | Issuer | Description | MT187384 | 01 | PA | TRAINING LICENSE | OTHER | 26232 | 01 | OK | OKLAHOMA MEDICAL LICENSE | OTHER |