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General NPI Number Information
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NPI Number | 1629010384
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Entity Type | Organization
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Legal Business Name | MERCY SPECIALTY SERVICES
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 1150 E SHERMAN BLVD STE 2400
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City | MUSKEGON
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State | MI
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Zip | 49444
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Country | US
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Telephone | 231-672-6336
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Fax | 231-672-6335
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Provider Business Mailing Address
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Address Line | PO BOX 776982
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City | CHICAGO
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State | IL
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Zip | 60677-6982
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Country | US
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Telephone | 800-494-5797
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MICHAEL GUSHO
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Credential |
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Telephone | 734-398-0642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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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 | MI
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | MI
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