Healthcare Provider Details

I. General information

NPI: 1982908455
Provider Name (Legal Business Name): MERCY HOSPITAL AND MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2010
Last Update Date: 12/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S MICHIGAN AVE 2-463
CHICAGO IL
60616-2333
US

IV. Provider business mailing address

3445 S RHODES AVE APT 204
CHICAGO IL
60616-4141
US

V. Phone/Fax

Practice location:
  • Phone: 312-567-2000
  • Fax:
Mailing address:
  • Phone: 646-318-8330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number125057355
License Number StateIL

VIII. Authorized Official

Name: DR. STEVEN POTTS
Title or Position: PROGRAM DIRECTOR
Credential: D.O
Phone: 312-567-2000