Provider Demographics
NPI:1861432692
Name:MERCY URGENT CARE
Entity type:Organization
Organization Name:MERCY URGENT CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER, THMG
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MERREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-685-1837
Mailing Address - Street 1:1670 E SHERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1863
Mailing Address - Country:US
Mailing Address - Phone:231-672-3600
Mailing Address - Fax:231-672-3601
Practice Address - Street 1:1670 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1863
Practice Address - Country:US
Practice Address - Phone:231-672-3600
Practice Address - Fax:231-672-3601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-08
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207P00000X, 363A00000X, 363L00000X, 207Q00000X, 207P00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N27520OtherMEDICARE GROUP PTAN
MI0N44880Medicare ID - Type Unspecified
MI0N44890Medicare ID - Type Unspecified