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General NPI Number Information
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NPI Number | 1114113222
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Entity Type | Organization
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Legal Business Name | MERCURY CENTER PA
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Dates
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Enumeration Date | 09/21/2007
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Last Update Date | 05/31/2008
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Provider Practice Location Address
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Address Line | 7775 LAKE WORTH RD
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City | LAKE WORTH
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State | FL
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Zip | 33467-2536
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Country | US
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Telephone | 561-967-6800
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Fax | 561-967-0975
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Provider Business Mailing Address
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Address Line | 7775 LAKE WORTH RD
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City | LAKE WORTH
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State | FL
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Zip | 33467-2536
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Country | US
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Telephone | 561-967-6800
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Fax | 561-967-0975
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER RICHARD OLDRICH
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Credential | DPM
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Telephone | 561-967-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO2584
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License Number State | FL
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