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Organization
MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA
Active
Organization
MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA
Active
Other names
Mercy Medical Associates at Providence
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS C SMITH (VP FINANCIAL SERVICES)
(610) 567-6964
Entity
Organization
Contact information
Practice address
831 PROVIDENCE RD, SECANE, PA 19018-2921
(610) 934-1234
(610) 934-4811
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
—
1007787930172
—
PA
01
—
1147948
AETNA HMO PPO
PA
01
—
1772599
BLUE SHIELD
PA
01
—
2455345001
KEYSTONE HEALTH PLAN EAST
PA
01
—
30035743
KEYSTONE MERCY HEALTHPLAN
PA
01
—
37229
HEALTHPARTNERS
PA
Enumeration date
10/24/2005
Last updated
03/20/2008
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