Healthcare Provider Details

I. General information

NPI: 1154910172
Provider Name (Legal Business Name): MERCY HEALTH PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 S STATE ST
SHELBY MI
49455-1228
US

IV. Provider business mailing address

72 S STATE ST
SHELBY MI
49455-1228
US

V. Phone/Fax

Practice location:
  • Phone: 231-861-3001
  • Fax: 231-861-5100
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: BETTY ELLER
Title or Position: CREDENTIALING
Credential:
Phone: 231-672-2120