Healthcare Provider Details

I. General information

NPI: 1972576908
Provider Name (Legal Business Name): MERCY HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 AGARD AVE
BENTON HARBOR MI
49022-4051
US

IV. Provider business mailing address

960 AGARD AVE
BENTON HARBOR MI
49022-4051
US

V. Phone/Fax

Practice location:
  • Phone: 269-927-5162
  • Fax: 269-927-5319
Mailing address:
  • Phone: 269-927-5162
  • Fax: 269-927-5319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateMI

VIII. Authorized Official

Name: MS. MARY GEEGAN MIDDLETON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 269-684-0259