Healthcare Provider Details

I. General information

NPI: 1093132946
Provider Name (Legal Business Name): MERCY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FORE RIVER PKWY
PORTLAND ME
04102-2779
US

IV. Provider business mailing address

175 FORE RIVER PKWY
PORTLAND ME
04102-2779
US

V. Phone/Fax

Practice location:
  • Phone: 207-553-6105
  • Fax: 207-553-6168
Mailing address:
  • Phone: 207-553-6105
  • Fax: 207-553-6168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number37636
License Number StateME

VIII. Authorized Official

Name: MISS THERESA MARIE HUCK
Title or Position: REIMBURSEMENT TECH
Credential: CPAT
Phone: 207-831-5995