Healthcare Provider Details

I. General information

NPI: 1003201955
Provider Name (Legal Business Name): MERCY HOSPITAL CARTHAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 DR RUSSELL SMITH WAY
CARTHAGE MO
64836
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 TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number523-4
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number523-4
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number523-4
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number523-4
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number523-4
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number523-4
License Number StateMO
# 7
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: SHERRY LYNN CLOUSE DAY
Title or Position: CFO
Credential: AO
Phone: 417-820-8439