# MERCY PROFESSIONAL SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912951468
- **Authorized official:** STEPHANIE RIEMER-MATUZAK (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (989) 348-5461

## Contact information

- **Practice address:** 1100 E MICHIGAN AVE, GRAYLING, MI 49738-1312
- **Practice address phone:** (989) 348-5461
- **Mailing address:** PO BOX 646, GRAYLING, MI 49738-0646
- **Mailing address phone:** (989) 348-1040

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |

## Other

- **Enumeration date:** 05/20/2006
- **Last updated:** 02/08/2008