Provider Demographics
NPI:1548637986
Name:MERCY HEALTH
Entity type:Organization
Organization Name:MERCY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-728-1663
Mailing Address - Street 1:420 WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-3299
Mailing Address - Country:US
Mailing Address - Phone:231-744-4743
Mailing Address - Fax:
Practice Address - Street 1:420 WHITEHALL RD
Practice Address - Street 2:
Practice Address - City:NORTH MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-3299
Practice Address - Country:US
Practice Address - Phone:231-744-4743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007498261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care