Healthcare Provider Details

I. General information

NPI: 1053368761
Provider Name (Legal Business Name): MERCY HOSPITAL SPRINGFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HOSPITAL DR
LEBANON MO
65536-9215
US

IV. Provider business mailing address

200 HOSPITAL DR
LEBANON MO
65536-9215
US

V. Phone/Fax

Practice location:
  • Phone: 417-533-6770
  • Fax: 417-533-6777
Mailing address:
  • Phone: 417-533-6770
  • Fax: 417-533-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number006619
License Number StateMO

VIII. Authorized Official

Name: MR. PATRICK BERRY
Title or Position: EXEC DIR-RETAIL PHARMACY SVCS
Credential:
Phone: 314-628-5606