Healthcare Provider Details

I. General information

NPI: 1235563651
Provider Name (Legal Business Name): MMS MERCY PHILADELPHIA HOSPITAL UROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W ELM ST SUITE 100
CONSHOHOCKEN PA
19428-4108
US

IV. Provider business mailing address

501 S 54TH ST SUITE 126
PHILADELPHIA PA
19143-1900
US

V. Phone/Fax

Practice location:
  • Phone: 610-567-6964
  • Fax: 610-567-6955
Mailing address:
  • Phone: 215-748-9872
  • Fax: 215-748-9869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. PHYLLIS HILKER
Title or Position: REGIONAL DIRECTOR
Credential:
Phone: 610-567-5529