Healthcare Provider Details

I. General information

NPI: 1740517341
Provider Name (Legal Business Name): MERCY CLINIC JOPLIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 BARKER DR
OSWEGO KS
67356
US

IV. Provider business mailing address

645 MARYVILLE CENTRE DR FL 3
SAINT LOUIS MO
63141-5855
US

V. Phone/Fax

Practice location:
  • Phone: 620-795-2525
  • Fax:
Mailing address:
  • Phone: 417-820-7133
  • Fax: 417-820-0586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateKS

VIII. Authorized Official

Name: TRACY A GODFREY
Title or Position: PRESIDENT
Credential: MD
Phone: 417-556-8962