Healthcare Provider Details

I. General information

NPI: 1952609059
Provider Name (Legal Business Name): MERCY LIFE OF ALABAMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 SPRINGHILL AVE
MOBILE AL
36607-1822
US

IV. Provider business mailing address

PO BOX 1090
DAPHNE AL
36526-1090
US

V. Phone/Fax

Practice location:
  • Phone: 251-287-8420
  • Fax: 251-621-4234
Mailing address:
  • Phone: 251-287-8420
  • Fax: 251-621-4234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number StateAL

VIII. Authorized Official

Name: DIANE LANCASTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 251-621-4452