MEDICARE: MERCY HEALTH NETWORK OF THE SOUTHERN REGION, INC.

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	207Q00000X	Family Medicine Physician
2	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1083781058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY HEALTH NETWORK OF THE SOUTHERN REGION, INC.

Provider Business Mailing Address
First Line	:	4401 W MEMORIAL RD
Second Line	:	SUITE #141, ATTENTION BECKY
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1785
Country	:	US
Telephone Number	:	405-936-5800
Fax Number	:	405-936-5810

Provider Business Practice Location Address
First Line	:	107 S 3RD ST
Second Line	:
City	:	DAVIS
State	:	OK
Zip	:	73030-2305
Country	:	US
Telephone Number	:	580-369-2803
Fax Number	:	580-369-3497

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	BOBBY G. THOMPSON
Credential	:
Telephone Number	:	580-220-6611

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	09/11/2025

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