Healthcare Provider Details

I. General information

NPI: 1306935143
Provider Name (Legal Business Name): MERCY PRIMARY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 LOCUST ST
PITTSBURGH PA
15219-5114
US

IV. Provider business mailing address

680 ANDERSEN DRIVE MED 3000 ATTN SCOTT MADDEN
PITTSBURGH PA
15220-2759
US

V. Phone/Fax

Practice location:
  • Phone: 412-937-8887
  • Fax: 412-937-9221
Mailing address:
  • Phone: 412-937-8887
  • Fax: 412-937-9221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: STACEY M LANG
Title or Position: COO
Credential:
Phone: 412-232-7545