Provider Demographics
NPI:1316627771
Name:MERCY MEDICAL CLINIC PA
Entity type:Organization
Organization Name:MERCY MEDICAL CLINIC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LANRE
Authorized Official - Middle Name:
Authorized Official - Last Name:LADIPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-833-8037
Mailing Address - Street 1:9510 UNIVERSITY CITY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-3997
Mailing Address - Country:US
Mailing Address - Phone:704-833-8037
Mailing Address - Fax:704-691-0415
Practice Address - Street 1:9510 UNIVERSITY CITY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-3997
Practice Address - Country:US
Practice Address - Phone:704-833-8037
Practice Address - Fax:704-691-0415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty