=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497906333
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERCY MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2008
-----------------------------------------------------
Last Update Date | 10/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 SAINT PAUL PL
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21202-2102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-951-1726
-----------------------------------------------------
Fax | 410-951-1752
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 SAINT PAUL PL
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21202-2102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-951-1726
-----------------------------------------------------
Fax | 410-951-1752
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AR SPECIALIST
-----------------------------------------------------
Name | MRS. SHERRELL L WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-951-1726
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------