Healthcare Provider Details

I. General information

NPI: 1215992524
Provider Name (Legal Business Name): MERCY MEDICAL, A CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 DAUPHIN ST
MOBILE AL
36608-1725
US

IV. Provider business mailing address

PO BOX 1090
DAPHNE AL
36526-1090
US

V. Phone/Fax

Practice location:
  • Phone: 251-344-7126
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number12631
License Number StateAL

VIII. Authorized Official

Name: MARY KAY POLYS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 251-621-4223