Healthcare Provider Details

I. General information

NPI: 1629078712
Provider Name (Legal Business Name): MERCY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
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: 207-879-3000
  • Fax:
Mailing address:
  • Phone: 207-879-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number36899
License Number StateME

VIII. Authorized Official

Name: MISS THERESA MARIE HUCK
Title or Position: DELEGATED OFFICIAL
Credential:
Phone: 207-879-3155