Healthcare Provider Details

I. General information

NPI: 1457344301
Provider Name (Legal Business Name): MERCY PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 WOODLAND HILLS BLVD
FORT SCOTT KS
66701-8798
US

IV. Provider business mailing address

403 WOODLAND HILLS BLVD
FORT SCOTT KS
66701-8798
US

V. Phone/Fax

Practice location:
  • Phone: 620-223-8040
  • Fax: 620-223-8524
Mailing address:
  • Phone: 620-223-8040
  • Fax: 620-223-8524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number05-28424
License Number StateKS

VIII. Authorized Official

Name: MRS. SARA K RAGSDALE
Title or Position: FAMILY PHYSICIAN
Credential: D.O
Phone: 620-223-8040