Healthcare Provider Details

I. General information

NPI: 1487963294
Provider Name (Legal Business Name): MERCY HOSPITAL OF PHILADELPHIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S 54TH ST
PHILADELPHIA PA
19143-1900
US

IV. Provider business mailing address

501 S 54TH ST
PHILADELPHIA PA
19143-1900
US

V. Phone/Fax

Practice location:
  • Phone: 214-748-9797
  • Fax:
Mailing address:
  • Phone: 214-748-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberSP005841C
License Number StatePA

VIII. Authorized Official

Name: MS. DOLORES A DUVAK
Title or Position: CRNP
Credential: CRNP
Phone: 215-748-9707