Organization
MERCY CARE
Active
Other names
Mercy Care-Palliative Care Partners
Organization subpart
No
Provider details
NPI number
Authorized official
SARA JO FAUCHER (EXECUTIVE DIRECTOR)
(843) 848-6480
Entity
Organization
Contact information
Practice address
8216 DEVON CT, MYRTLE BEACH, SC 29572-4178
(843) 848-6480
(843) 848-6655
Mailing address
8216 DEVON CT, MYRTLE BEACH, SC 29572-4178
(843) 848-6480
(843) 848-6655
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
HPC-0053
SC
207Q00000X
Family Medicine Physician
HPC-0053
SC
207R00000X
Internal Medicine Physician
Primary
HPC-0053
SC
363LF0000X
Family Nurse Practitioner
HPC-0053
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000191785
BLUECROSS BLUESHIELD OF SC CREDENTIALING FOR PALLIATIVE CARE VISITS
SC
01
—
8244
OLD, DEACTIVATED MEDICARE B PTAN (PRIOR TO 2009)
SC
01
—
DQ8026
MEDICARE RAILROAD
SC
05
—
GP5545
—
SC
Enumeration date
06/11/2009
Last updated
06/13/2012
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