MEDICARE: MERCY CLINIC CHILDREN'S PALLIATIVE CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1023383742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY CLINIC CHILDREN'S PALLIATIVE CARE LLC

Provider Business Mailing Address
First Line	:	621 S NEW BALLAS RD STE 6006B
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8273
Country	:	US
Telephone Number	:	314-251-6299
Fax Number	:	314-251-4450

Provider Business Practice Location Address
First Line	:	621 S NEW BALLAS RD
Second Line	:	SUITE 6006-B
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8232
Country	:	US
Telephone Number	:	314-251-6299
Fax Number	:	314-251-4450

Authorized Official
Title or Position	:	CFO
Name	:	JONATHAN TYLER STURGEON
Credential	:
Telephone Number	:	314-251-1917

Provider Enumeration Date	:	03/13/2012
Last Update Date	:	03/02/2026

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