Provider Demographics
NPI:1285336362
Name:MERCYLAND MEDICAL MANAGEMENT, PLLC
Entity type:Organization
Organization Name:MERCYLAND MEDICAL MANAGEMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KEY III
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-432-1568
Mailing Address - Street 1:16000 W 9 MILE RD STE 408
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4839
Mailing Address - Country:US
Mailing Address - Phone:248-432-1568
Mailing Address - Fax:248-493-6155
Practice Address - Street 1:16000 W 9 MILE RD STE 408
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4839
Practice Address - Country:US
Practice Address - Phone:248-432-1568
Practice Address - Fax:248-493-6155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center