MEDICARE: MERCY HOSPITAL JEFFERSON

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	282N00000X	General Acute Care Hospital	160-47	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	:	1508859661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY HOSPITAL JEFFERSON

Provider Business Mailing Address
First Line	:	1400 US HIGHWAY 61
Second Line	:
City	:	FESTUS
State	:	MO
Zip	:	63028-4100
Country	:	US
Telephone Number	:	636-933-1000
Fax Number	:	636-933-1819

Provider Business Practice Location Address
First Line	:	1400 HIGHWAY 61
Second Line	:
City	:	FESTUS
State	:	MO
Zip	:	63028-4100
Country	:	US
Telephone Number	:	636-933-1000
Fax Number	:	636-933-1819

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAN ECKENFELS
Credential	:
Telephone Number	:	636-933-1107

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	04/09/2024

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Directions to “MERCY HOSPITAL JEFFERSON ” Practice Location

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