Provider Demographics
NPI:1326381880
Name:MERCY HOUSECALL PHYSICIANS GROUP, LLC
Entity type:Organization
Organization Name:MERCY HOUSECALL PHYSICIANS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:EBERE
Authorized Official - Middle Name:ISRAEL
Authorized Official - Last Name:AZUBUIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-942-2377
Mailing Address - Street 1:501 WYNNRWOOD VILLAGE
Mailing Address - Street 2:STE102A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224
Mailing Address - Country:US
Mailing Address - Phone:214-942-2377
Mailing Address - Fax:214-942-2977
Practice Address - Street 1:501 WYNNRWOOD VILLAGE
Practice Address - Street 2:STE 102A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224
Practice Address - Country:US
Practice Address - Phone:214-942-2377
Practice Address - Fax:214-942-2977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9136261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM9136OtherLICENSE