Healthcare Provider Details

I. General information

NPI: 1073883161
Provider Name (Legal Business Name): MERCY LIFE CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 SOUTH 9TH STREET
PITTSBURGH PA
15203
US

IV. Provider business mailing address

1200 REEDSDALE ST
PITTSBURGH PA
15233-2109
US

V. Phone/Fax

Practice location:
  • Phone: 412-697-3260
  • Fax: 412-697-3263
Mailing address:
  • Phone: 412-697-0712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA ANGLUM
Title or Position: PATIENT ACCOUNTING MANAGER
Credential:
Phone: 412-697-0712