MEDICARE: MERCY MEDICAL, A CORPORATION

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	314000000X	Skilled Nursing Facility	12631	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	012353	OTHER	AL	BC DSF SNF PROVIDER NUMBE
2	010347	OTHER	AL	BC SNF PROVIDER NUMBER
3	9245	OTHER	AL	HEALTHSPRING PROVIDER NUM

General Provider Information

NPI Number	:	1215992524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY MEDICAL, A CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 1090
Second Line	:
City	:	DAPHNE
State	:	AL
Zip	:	36526-1090
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3712 DAUPHIN ST
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36608-1725
Country	:	US
Telephone Number	:	251-344-7126
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MARY KAY POLYS
Credential	:
Telephone Number	:	251-621-4223

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/13/2007

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Directions to “MERCY MEDICAL, A CORPORATION ” Practice Location

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