Healthcare Provider Details

I. General information

NPI: 1285640912
Provider Name (Legal Business Name): MERCY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 E. PACK STREET
MOUNDRIDGE KS
67107-0180
US

IV. Provider business mailing address

PO BOX 180 218 E. PACK STREET
MOUNDRIDGE KS
67107-0180
US

V. Phone/Fax

Practice location:
  • Phone: 620-345-6391
  • Fax: 620-345-6344
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License NumberH059003
License Number StateKS

VIII. Authorized Official

Name: MR. ROYCE HOLDEMAN
Title or Position: CFO
Credential:
Phone: 620-345-6391