MEDICARE: MERCY LIFE CENTER CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	165912	OTHER	PA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1604175	OTHER	PA	GATEWAY HEALTH PLANS
3	2684111	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1073883161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY LIFE CENTER CORP

Provider Business Mailing Address
First Line	:	1200 REEDSDALE ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15233-2109
Country	:	US
Telephone Number	:	412-697-0712
Fax Number	:

Provider Business Practice Location Address
First Line	:	249 SOUTH 9TH STREET
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15203
Country	:	US
Telephone Number	:	412-697-3260
Fax Number	:	412-697-3263

Authorized Official
Title or Position	:	PATIENT ACCOUNTING MANAGER
Name	:	AMANDA ANGLUM
Credential	:
Telephone Number	:	412-697-0712

Provider Enumeration Date	:	01/05/2012
Last Update Date	:	01/14/2026

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Directions to “MERCY LIFE CENTER CORP ” Practice Location

Language	Start Address	Practice Location

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