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NPI Code Detail

MEDICARE: SAINT JOSEPH'S MERCY CARE SERVICES, INC.

MEDICARE: SAINT JOSEPH'S MERCY CARE SERVICES, INC.
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
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689921306
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAINT JOSEPH'S MERCY CARE SERVICES, INC.
Provider Business Mailing Address
First Line : 424 DECATUR ST SE
Second Line :
City : ATLANTA
State : GA
Zip : 30312-1848
Country : US
Telephone Number : 678-843-8600
Fax Number : 678-843-8601
Provider Business Practice Location Address
First Line : 1300 JOSEPH E BOONE BLVD NW
Second Line :
City : ATLANTA
State : GA
Zip : 30314-2032
Country : US
Telephone Number : 678-843-8500
Fax Number : 678-843-8501
Authorized Official
Title or Position : PRESIDENT
Name : MR. E THOMAS ANDREWS
Credential :
Telephone Number : 678-843-8502
Provider Enumeration Date : 08/13/2012
Last Update Date : 08/11/2015

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Directions to “SAINT JOSEPH'S MERCY CARE SERVICES, INC. ” Practice Location

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