# MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MMS-Mercy Hospital of Philadelphia
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396721494
- **Authorized official:** MR. DOUGLAS C SMITH (VP FINANCIAL SERVICES)
- **Authorized official phone:** (610) 567-6964

## Contact information

- **Practice address:** 501 S 54TH ST, PHILADELPHIA, PA 19143-1900
- **Practice address phone:** (215) 748-9707
- **Practice address fax:** (215) 748-9708
- **Mailing address:** 1 W ELM ST, 2ND FLOOR, CONSHOHOCKEN, PA 19428-2007
- **Mailing address phone:** (610) 567-6964
- **Mailing address fax:** (610) 567-6170

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/20/2005
- **Last updated:** 05/08/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100778793 0157 | — | PA |
| 01 | — | 125183600 | DEPT OF LABOR | PA |
| 01 | — | 1543646 | BLUE SHIELD PA PR | PA |
| 01 | — | 1543648 | AMERIHEALTH ADMIN | PA |
| 01 | — | 2228313000 | AMERIHEALTH NEW JERSEY | PA |
| 01 | — | 2507496 | AETNA HMO SPECIALIST | PA |
| 01 | — | 33695 | HEALTH PARTNERS | PA |
| 01 | — | 7770198 | AETNA OTHER | PA |
| 01 | — | G000668600 | AMERICHOICE | PA |