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General NPI Number Information
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NPI Number | 1275701161
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Entity Type | Organization
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Legal Business Name | MERCY PROFESSIONAL SERVICES
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 11/30/2009
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Provider Practice Location Address
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Address Line | 7985 MACKINAW TRL STE 201
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City | CADILLAC
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State | MI
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Zip | 49601-8111
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Country | US
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Telephone | 231-779-5277
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 533
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City | GRAYLING
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State | MI
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Zip | 49738
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Country | US
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Telephone | 989-348-0054
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOHN L MACLEOD
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Credential |
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Telephone | 231-876-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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