Healthcare Provider Details

I. General information

NPI: 1477822567
Provider Name (Legal Business Name): MERCY CLINIC JOPLIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
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: 417-237-7240
Mailing address:
  • Phone: 417-358-8121
  • Fax: 417-237-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MATHEW JANSENS
Title or Position: CFO
Credential:
Phone: 417-556-2459