Organization
MERCY MEDICAL DEVELOPMENT INC
Active
Other names
Mercy Outpatient Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY MASHBURN (CFO)
(305) 854-4400
Entity
Organization
Contact information
Practice address
3641 S MIAMI AVE, MIAMI, FL 33133-4205
(305) 860-4660
(305) 860-4682
Mailing address
PO BOX 331966, MIAMI, FL 33233-1966
(305) 860-4660
(305) 860-4682
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
—
—
207UN0901X
Nuclear Cardiology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0203X
Therapeutic Radiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060942100
—
FL
Enumeration date
11/18/2005
Last updated
05/29/2008
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