Healthcare Provider Details

I. General information

NPI: 1679604797
Provider Name (Legal Business Name): MERCY HOSPITAL SOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 12/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 GRAVOIS RD
FENTON MO
63026-7727
US

IV. Provider business mailing address

714 GRAVOIS RD
FENTON MO
63026-7727
US

V. Phone/Fax

Practice location:
  • Phone: 636-326-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MS. CHERYL MATEJKA
Title or Position: CFO EAST COMMUNITIES & SFO
Credential:
Phone: 314-251-1958