Healthcare Provider Details

I. General information

NPI: 1184453748
Provider Name (Legal Business Name): MERCY MEDICAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 FACTORY OUTLET DR STE 12
ARCADIA LA
71001-3057
US

IV. Provider business mailing address

PO BOX 70
HODGE LA
71247-0070
US

V. Phone/Fax

Practice location:
  • Phone: 318-781-2310
  • Fax: 318-781-2312
Mailing address:
  • Phone: 318-259-1100
  • Fax: 318-259-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY G. BRUNSON
Title or Position: CEO
Credential:
Phone: 318-259-1100