Healthcare Provider Details

I. General information

NPI: 1558500462
Provider Name (Legal Business Name): MERCY SPECIALIST PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CAREW ST SUITE 1
SPRINGFIELD MA
01104
US

IV. Provider business mailing address

91 STILES RD
SALEM NH
03079-5804
US

V. Phone/Fax

Practice location:
  • Phone: 413-781-2211
  • Fax:
Mailing address:
  • Phone: 603-890-4420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES M HARRIS
Title or Position: REGIONAL DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 860-714-4396