Healthcare Provider Details

I. General information

NPI: 1558628222
Provider Name (Legal Business Name): MERCY HOSPITAL CARTHAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HAZEL ST
CARTHAGE MO
64836-2850
US

IV. Provider business mailing address

1515 HAZEL ST
CARTHAGE MO
64836-2850
US

V. Phone/Fax

Practice location:
  • Phone: 417-358-0188
  • Fax:
Mailing address:
  • Phone: 417-358-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHERRY LYNN CLOUSE DAY
Title or Position: VP FINANCE
Credential:
Phone: 417-820-8439