Provider Demographics
NPI:1750360798
Name:THE MERCY HOSPITAL INC
Entity type:Organization
Organization Name:THE MERCY HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-714-4396
Mailing Address - Street 1:PO BOX 414432
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-4432
Mailing Address - Country:US
Mailing Address - Phone:413-748-9000
Mailing Address - Fax:
Practice Address - Street 1:271 CAREW ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104
Practice Address - Country:US
Practice Address - Phone:413-748-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MERCY HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35261QM1300X, 261QR0400X, 282N00000X, 273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110027346GMedicaid
CT3032356Medicaid
MA2222006601OtherBLUE CROSS OF MASS. INPT
MA110027346EMedicaid
CT3023942Medicaid
MA2222006610OtherBLUE CROSS OF MASS. OUTPT
MA2222006601OtherBLUE CROSS OF MASS. INPT
MAM21671Medicare Oscar/Certification
MA220066Medicare Oscar/Certification