MEDICARE: MERCURY CENTER PA

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	213E00000X	Podiatrist	PO2584	FL

General Provider Information

NPI Number	:	1114113222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCURY CENTER PA

Provider Business Mailing Address
First Line	:	7775 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2536
Country	:	US
Telephone Number	:	561-967-6800
Fax Number	:	561-967-0975

Provider Business Practice Location Address
First Line	:	7775 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2536
Country	:	US
Telephone Number	:	561-967-6800
Fax Number	:	561-967-0975

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRISTOPHER RICHARD OLDRICH
Credential	:	DPM
Telephone Number	:	561-967-6800

Provider Enumeration Date	:	09/21/2007
Last Update Date	:	05/31/2008

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