MEDICARE: MERCY CARE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1063084366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY CARE CENTER

Provider Business Mailing Address
First Line	:	3753 S COTTAGE GROVE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-1662
Country	:	US
Telephone Number	:	312-567-2092
Fax Number	:

Provider Business Practice Location Address
First Line	:	3753 S COTTAGE GROVE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-1662
Country	:	US
Telephone Number	:	312-567-2092
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DAISY RODRIGUEZ
Credential	:
Telephone Number	:	773-451-0465

Provider Enumeration Date	:	07/15/2021
Last Update Date	:	12/27/2022

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Directions to “MERCY CARE CENTER ” Practice Location

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