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General NPI Number Information
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NPI Number | 1710965124
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Entity Type | Organization
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Legal Business Name | MERCY HOSPITAL OF WATERTOWN UNITED STATES CATHOLIC CONFERENCE
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 10/02/2013
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Provider Practice Location Address
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Address Line | 199 PRATT ST
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City | WATERTOWN
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State | NY
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Zip | 13601-4349
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Country | US
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Telephone | 315-782-0415
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Fax | 315-786-0417
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Provider Business Mailing Address
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Address Line | 199 PRATT ST
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City | WATERTOWN
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State | NY
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Zip | 13601-4349
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Country | US
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Telephone | 315-782-0415
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Fax | 315-786-0417
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Authorized Official
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Title or Position | DPS/ADMINISTRATOR
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Name | MS. TERRI L BRAY
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Credential | R.N.
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Telephone | 315-782-0415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2472R0900X
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Taxonomy Name | Renal Dialysis Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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