Healthcare Provider Details

I. General information

NPI: 1396857504
Provider Name (Legal Business Name): MERCY MANAGEMENT OF SEPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 S LANSDOWNE AVE
YEADON PA
19050-2405
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 610-626-9800
  • Fax: 610-237-4202
Mailing address:
  • Phone: 610-567-6967
  • Fax: 610-567-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS C. SMITH
Title or Position: PATIENT ACCOUNTS VP
Credential: V.P.
Phone: 610-567-6967