Provider Demographics
NPI:1912706565
Name:MERCY MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:MERCY MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:904-476-3305
Mailing Address - Street 1:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32004-0491
Mailing Address - Country:US
Mailing Address - Phone:904-476-3305
Mailing Address - Fax:904-476-3305
Practice Address - Street 1:3404 S ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH SHORES
Practice Address - State:FL
Practice Address - Zip Code:32118-6311
Practice Address - Country:US
Practice Address - Phone:904-476-3305
Practice Address - Fax:904-476-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies