Healthcare Provider Details

I. General information

NPI: 1043549322
Provider Name (Legal Business Name): MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 LANSDOWNE AVE 3001
DARBY PA
19023-1330
US

IV. Provider business mailing address

1 W ELM ST 100
CONSHOHOCKEN PA
19428-4108
US

V. Phone/Fax

Practice location:
  • Phone: 610-586-4100
  • Fax: 610-586-4114
Mailing address:
  • Phone: 610-567-6964
  • Fax: 610-567-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUGLAS C SMITH
Title or Position: VP PATIENT FINANCIAL SERVICES
Credential:
Phone: 610-567-6000