Provider Demographics
NPI:1174587067
Name:MERCY MEDICAL, A CORPORATION
Entity type:Organization
Organization Name:MERCY MEDICAL, A CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NECIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BORRONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-459-6454
Mailing Address - Street 1:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-1090
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:374 GREENO RD S
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1916
Practice Address - Country:US
Practice Address - Phone:251-621-4431
Practice Address - Fax:251-621-4896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11712251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALMER7034AMedicaid
AL017034OtherMEDICARE OSCAR NUMBER
AL51535174OtherBC BS OF AL PROVER NUMBER
AL9245OtherHEALTHSPRING PROVIDER NUM
AL51041160OtherBCBS OF AL PROVIDER NUM
AL9245OtherHEALTHSPRING PROVIDER NUM