Provider Demographics
NPI:1174700694
Name:MERCY MEMORIAL HOSPITAL CORPORATION
Entity type:Organization
Organization Name:MERCY MEMORIAL HOSPITAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP REP
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-240-1440
Mailing Address - Street 1:100 POWELL DR
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:MI
Mailing Address - Zip Code:48131-8644
Mailing Address - Country:US
Mailing Address - Phone:734-240-1440
Mailing Address - Fax:734-240-1550
Practice Address - Street 1:100 POWELL DR
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131-8644
Practice Address - Country:US
Practice Address - Phone:734-240-1440
Practice Address - Fax:734-240-1550
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:URGENT CARE PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E81101OtherBLUE CROSS