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General NPI Number Information
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NPI Number | 1629078712
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Entity Type | Organization
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Legal Business Name | MERCY HOSPITAL
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 04/15/2022
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Provider Practice Location Address
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Address Line | 175 FORE RIVER PKWY
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City | PORTLAND
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State | ME
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Zip | 04102-2779
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Country | US
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Telephone | 207-879-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 175 FORE RIVER PKWY
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City | PORTLAND
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State | ME
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Zip | 04102-2779
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Country | US
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Telephone | 207-879-3000
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Fax |
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Authorized Official
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Title or Position | DELEGATED OFFICIAL
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Name | MISS THERESA MARIE HUCK
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Credential |
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Telephone | 207-879-3155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 36899
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License Number State | ME
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