MEDICARE: MERCY HEALTH CLINIC

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	174400000X	Specialist		MI

General Provider Information

NPI Number	:	1972576908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY HEALTH CLINIC

Provider Business Mailing Address
First Line	:	960 AGARD AVE
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-4051
Country	:	US
Telephone Number	:	269-927-5162
Fax Number	:	269-927-5319

Provider Business Practice Location Address
First Line	:	960 AGARD AVE
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-4051
Country	:	US
Telephone Number	:	269-927-5162
Fax Number	:	269-927-5319

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. MARY GEEGAN MIDDLETON
Credential	:
Telephone Number	:	269-684-0259

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	07/21/2022

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Directions to “MERCY HEALTH CLINIC ” Practice Location

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