Healthcare Provider Details

I. General information

NPI: 1770523490
Provider Name (Legal Business Name): MERCY HOSPITAL SPRINGFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 WEST MT. VERNON SUITE 130
NIXA MO
65714
US

IV. Provider business mailing address

1235 E CHEROKEE ST ATTN: ROB SHOCKLEY
SPRINGFIELD MO
65804-2203
US

V. Phone/Fax

Practice location:
  • Phone: 417-724-5350
  • Fax: 417-724-5354
Mailing address:
  • Phone: 417-820-6624
  • Fax: 417-820-7788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2005012026
License Number StateMO

VIII. Authorized Official

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