MEDICARE: OUR LADY OF MERCY MEDICAL CENTER

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	040403003073	OTHER	NY	FIDELIS PROVIDER NUMBER
2	000021	OTHER	NY	BLUE CROSS PROVIDER NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000821	OTHER	NY	BLUE CROSS PROVIDER NUMBER
5	HO3109	OTHER	NY	OXFORD PROVIDER NUMBER
6	HO3109A	OTHER	NY	OXFORD PROVIDER NUMBER

NPI Number	:	1235137431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR LADY OF MERCY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	100 CORPORATE DR
Second Line	:	CMO
City	:	YONKERS
State	:	NY
Zip	:	10701-6807
Country	:	US
Telephone Number	:	914-378-6163
Fax Number	:	914-709-0386

Provider Business Practice Location Address
First Line	:	600 E 233RD ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2604
Country	:	US
Telephone Number	:	718-920-9000
Fax Number	:	914-709-0386

Authorized Official
Title or Position	:	DIRECTOR PROVIDER SERVICES
Name	:	MISS MICHAEL G. DOWLING
Credential	:
Telephone Number	:	914-377-4668

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	08/07/2008

600 E 233RD ST , SUITE 3
BRONX, NY
10466-2604

Practice Phone: 718-920-2060
Practice Fax: 718-920-6889