MEDICARE: MERCY CARDIOLOGY 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	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1730182742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY CARDIOLOGY LLC

Provider Business Mailing Address
First Line	:	625 S NEW BALLAS RD
Second Line	:	STE 2030
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8253
Country	:	US
Telephone Number	:	314-251-5830
Fax Number	:	314-251-5803

Provider Business Practice Location Address
First Line	:	625 S NEW BALLAS RD
Second Line	:	STE 2030
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8253
Country	:	US
Telephone Number	:	314-251-5830
Fax Number	:	314-251-5803

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN G. HERMANN
Credential	:
Telephone Number	:	314-364-3380

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	04/07/2008

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