Provider Demographics
NPI:1124083761
Name:MERCY MEDICAL, A CORPORATION
Entity type:Organization
Organization Name:MERCY MEDICAL, A CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-621-4223
Mailing Address - Street 1:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-1090
Mailing Address - Country:US
Mailing Address - Phone:251-621-4431
Mailing Address - Fax:251-621-4899
Practice Address - Street 1:101 VILLA DR
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4653
Practice Address - Country:US
Practice Address - Phone:251-621-4431
Practice Address - Fax:251-621-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12474314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010347OtherBC SNF PROVIDER NUM DAPHN
AL9245OtherHEALTHSPRING PROVIDER NUM
AL015049Medicare Oscar/Certification