Provider Demographics
NPI:1396331328
Name:MERCY HEALTH URGENT CARE
Entity type:Organization
Organization Name:MERCY HEALTH URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP - REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-239-7190
Mailing Address - Street 1:1200 EAST CAMPBELL RD
Mailing Address - Street 2:SUITE 108 - LOCKBOX #676224
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-2730
Mailing Address - Country:US
Mailing Address - Phone:225-239-7190
Mailing Address - Fax:
Practice Address - Street 1:3100 PLAINFIELD AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-3261
Practice Address - Country:US
Practice Address - Phone:616-410-7701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care