# MERCY MEMORIAL HOSPITAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MERCY MEMORIAL OB SERVICES
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1659558765
- **Legal business name:** MERCY MEMORIAL OB SERVICES
- **Authorized official:** KIANOUSH KHAGHNAY MD (GROUP REP)
- **Authorized official phone:** (734) 240-1442

## Contact information

- **Practice address:** 718 N MACOMB ST, MONROE, MI 48162-7815
- **Practice address phone:** (734) 240-1440
- **Practice address fax:** (734) 240-1550
- **Mailing address:** 718 N MACOMB ST, MONROE, MI 48162-7815
- **Mailing address phone:** (734) 240-1440
- **Mailing address fax:** (734) 240-1550

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207VM0101X | Maternal & Fetal Medicine Physician | — | NULL | Yes |
| 207VM0101X | Maternal & Fetal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/31/2008
- **Last updated:** 01/31/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0E81076 | BLUE CROSS | MI |