Healthcare Provider Details

I. General information

NPI: 1518997469
Provider Name (Legal Business Name): MERCY REGIONAL HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 BAILEY LN
BENTON IL
62812-1921
US

IV. Provider business mailing address

205 BAILEY LN P O BOX 337
BENTON IL
62812-1921
US

V. Phone/Fax

Practice location:
  • Phone: 618-439-9400
  • Fax: 618-439-7138
Mailing address:
  • Phone: 618-439-9400
  • Fax: 618-439-7138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number6567
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number6567
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. CLAYTON WHEELER HOBBS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PARAMEDIC
Phone: 618-439-9400