MEDICARE: MERCY HOSPITAL &MEDICAL CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101Y00000X	Counselor	IL
2	176B00000X	Midwife	IL
3	207K00000X	Allergy & Immunology Physician	IL
4	207L00000X	Anesthesiology Physician
5	207Q00000X	Family Medicine Physician	IL
6	207RC0000X	Cardiovascular Disease Physician	IL
7	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	IL
8	207RG0100X	Gastroenterology Physician	IL
9	207RN0300X	Nephrology Physician	IL
10	207V00000X	Obstetrics & Gynecology Physician	IL
11	207W00000X	Ophthalmology Physician	IL
12	208000000X	Pediatrics Physician	IL
13	2084P0800X	Psychiatry Physician	IL
14	208600000X	Surgery Physician	IL
15	207R00000X	Internal Medicine Physician	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01621679	OTHER	IL	BCBS OF IL

General Provider Information

NPI Number	:	1215914791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY HOSPITAL &MEDICAL CENTER

Provider Business Mailing Address
First Line	:	28231 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1282
Country	:	US
Telephone Number	:	312-567-2118
Fax Number	:	312-328-7701

Provider Business Practice Location Address
First Line	:	2525 S MICHIGAN AVE
Second Line	:	ATT: PHYSICIAN BILLING/CREDENTIALING DEPT
City	:	CHICAGO
State	:	IL
Zip	:	60616-2315
Country	:	US
Telephone Number	:	312-567-7924
Fax Number	:	312-567-6189

Authorized Official
Title or Position	:	VP OF FINANCE
Name	:	SILIA MIGLIO
Credential	:
Telephone Number	:	312-567-2580

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	07/21/2022

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Directions to “MERCY HOSPITAL &MEDICAL CENTER ” Practice Location

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