Healthcare Provider Details

I. General information

NPI: 1003300286
Provider Name (Legal Business Name): MERCY CARTHAGE ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 DR RUSSELL SMITH WAY
CARTHAGE MO
64836-7402
US

IV. Provider business mailing address

3125 DR RUSSELL SMITH WAY
CARTHAGE MO
64836-7402
US

V. Phone/Fax

Practice location:
  • Phone: 417-358-8121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT WATSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 417-359-2653