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General NPI Number Information
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NPI Number | 1770605560
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Entity Type | Organization
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Legal Business Name | MERCY FAMILY HEALTH CENTER
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 10/29/2019
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Provider Practice Location Address
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Address Line | 3804 SOUTHLAND AVE
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City | KOKOMO
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State | IN
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Zip | 46902-3637
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Country | US
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Telephone | 765-864-0558
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Fax | 765-864-8370
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Provider Business Mailing Address
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Address Line | 3804 SOUTHLAND AVE
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City | KOKOMO
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State | IN
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Zip | 46902-3637
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Country | US
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Telephone | 765-864-0558
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Fax | 765-864-8370
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | ALEXANDRA C UDE
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Credential | CPA
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Telephone | 765-864-0558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 50004829A
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License Number State | IN
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