Provider Demographics
NPI:1801303086
Name:ST MARY MERCY PHYSICIAN PRACTICES
Entity type:Organization
Organization Name:ST MARY MERCY PHYSICIAN PRACTICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR REVENUE MANAGEMENT ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-343-0282
Mailing Address - Street 1:14555 LEVAN RD STE 310
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5085
Mailing Address - Country:US
Mailing Address - Phone:734-655-2989
Mailing Address - Fax:734-655-8590
Practice Address - Street 1:5555 CONNER ST STE 2691
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-3812
Practice Address - Country:US
Practice Address - Phone:313-692-8400
Practice Address - Fax:313-692-8431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty