Healthcare Provider Details

I. General information

NPI: 1235493776
Provider Name (Legal Business Name): MERCY CLINIC EAST COMMUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N OLD HIGHWAY 66
BOURBON MO
65441-6298
US

IV. Provider business mailing address

125 N OLD HIGHWAY 66
BOURBON MO
65441-6298
US

V. Phone/Fax

Practice location:
  • Phone: 573-679-2006
  • Fax:
Mailing address:
  • Phone: 573-679-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KERRY DUNGER
Title or Position: EXECUTIVE DIRECTOR - FINANCE
Credential:
Phone: 314-364-3707