Healthcare Provider Details

I. General information

NPI: 1285844688
Provider Name (Legal Business Name): MERCY ST JOHN'S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 HOSPITAL DR STE D
LEBANON MO
65536-9251
US

IV. Provider business mailing address

247 EMERALD LOOP
MARSHFIELD MO
65706-9010
US

V. Phone/Fax

Practice location:
  • Phone: 417-533-6315
  • Fax:
Mailing address:
  • Phone: 417-859-4173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number107422
License Number StateMO

VIII. Authorized Official

Name: MS. TERRI ANN FOSTER
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 417-533-6315