Provider Demographics
NPI:1306935143
Name:MERCY PRIMARY CARE INC
Entity type:Organization
Organization Name:MERCY PRIMARY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-232-7545
Mailing Address - Street 1:680 ANDERSEN DRIVE
Mailing Address - Street 2:MED 3000 ATTN SCOTT MADDEN
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-2759
Mailing Address - Country:US
Mailing Address - Phone:412-937-8887
Mailing Address - Fax:412-937-9221
Practice Address - Street 1:1400 LOCUST ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-5114
Practice Address - Country:US
Practice Address - Phone:412-937-8887
Practice Address - Fax:412-937-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1551082OtherGATEWAY HEALTH PLANS
PA15821240088Medicaid
PA1800680OtherHIGHMARK BSPA
PA20047086OtherAMERIHEALTH MERCY
PA422294OtherHEALTH AMERICA
PA498760OtherAETNA
PA000000176465OtherUNISON
PA422297OtherHEALTH ASSURANCE
PA422297OtherADVANTRA FREEDOM
PACC4486OtherRR MEDICARE
PA422297OtherHEALTH ASSURANCE