MEDICARE: MERCY HOSPITAL SOUTH

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	251E00000X	Home Health Agency	234-19	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053314179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY HOSPITAL SOUTH

Provider Business Mailing Address
First Line	:	10010 KENNERLY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2106
Country	:	US
Telephone Number	:	314-525-1000
Fax Number	:	314-525-4269

Provider Business Practice Location Address
First Line	:	9735 LANDMARK PARKWAY DR STE 2N
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1666
Country	:	US
Telephone Number	:	314-525-1045
Fax Number	:	314-525-4269

Authorized Official
Title or Position	:	CFO
Name	:	JONATHAN TYLER STURGEON
Credential	:
Telephone Number	:	314-525-1930

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/19/2024

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Directions to “MERCY HOSPITAL SOUTH ” Practice Location

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