Healthcare Provider Details

I. General information

NPI: 1396012753
Provider Name (Legal Business Name): MERCY HOSPITAL CARTHAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 08/27/2013
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: 417-358-8121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT COPELAND
Title or Position: CEO
Credential:
Phone: 417-358-8121