MEDICARE: MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA

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	282N00000X	General Acute Care Hospital

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	390156	OTHER	PA	MEDICARE ID TYPE UNSPECIFIED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001449	OTHER	PA	AETNA
2	0001023000	OTHER	PA	IBC
3	0001023000	OTHER	PA	KEYSTONE EAST
5	08378	OTHER	PA	HEALTH PARTNERS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	60002	OTHER	PA	KMHP
8	76233301	OTHER	PA	AMERICHOICE

General Provider Information

NPI Number	:	1861486698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA

Provider Business Mailing Address
First Line	:	1 W ELM ST
Second Line	:	SUITE 100
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2007
Country	:	US
Telephone Number	:	610-567-6000
Fax Number	:	610-567-6611

Provider Business Practice Location Address
First Line	:	501 S 54TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-1900
Country	:	US
Telephone Number	:	215-748-9000
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. JOSEPH H BRADLEY
Credential	:
Telephone Number	:	610-567-6771

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	11/05/2009

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Directions to “MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA ” Practice Location

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