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General NPI Number Information
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NPI Number | 1215992524
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Entity Type | Organization
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Legal Business Name | MERCY MEDICAL, A CORPORATION
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 3712 DAUPHIN ST
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City | MOBILE
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State | AL
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Zip | 36608-1725
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Country | US
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Telephone | 251-344-7126
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1090
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City | DAPHNE
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State | AL
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Zip | 36526-1090
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MARY KAY POLYS
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Credential |
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Telephone | 251-621-4223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 12631
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License Number State | AL
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