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Organization
MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA
Active
Organization
MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA
Active
Other names
MMS-Mercy Medical Associates at Eastwick
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUG;AS C SMITH (VP FINANCIAL SERVICES)
(610) 567-6964
Entity
Organization
Contact information
Practice address
2821 ISLAND AVE, SUITE D& E, PHILADELPHIA, PA 19153-2300
(215) 863-6110
(215) 863-6111
Mailing address
1 W ELM ST, 2ND FLOOR, CONSHOHOCKEN, PA 19428-2007
(610) 567-6964
(610) 567-6170
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100778793 0152
—
PA
01
—
125186900
DEPT OF LABOR
PA
01
—
1551070
AMERIHEALTH ADMIN
PA
01
—
2059546
AETNA MEDICARE
PA
01
—
2234269001
AMERIHEALTH DELAWARE
PA
01
—
30010759
KEYSTONE MERCY
PA
Enumeration date
12/20/2005
Last updated
05/09/2008
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