Healthcare Provider Details

I. General information

NPI: 1275772469
Provider Name (Legal Business Name): MERCY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 S MIAMI AVE
MIAMI FL
33133-4253
US

IV. Provider business mailing address

3663 S MIAMI AVE
MIAMI FL
33133-4253
US

V. Phone/Fax

Practice location:
  • Phone: 305-285-2121
  • Fax: 305-285-2114
Mailing address:
  • Phone: 305-285-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4002
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number4002
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4002
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4002
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4002
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number4002
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4002
License Number StateFL

VIII. Authorized Official

Name: JOHN C JOHNSON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 305-854-4400