Healthcare Provider Details

I. General information

NPI: 1720767940
Provider Name (Legal Business Name): MERCY HOSPITAL PERRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 07/14/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 EDGEMONT BLVD
PERRYVILLE MO
63775-1231
US

IV. Provider business mailing address

1508 EDGEMONT BLVD
PERRYVILLE MO
63775-1231
US

V. Phone/Fax

Practice location:
  • Phone: 573-768-3220
  • Fax: 573-768-3221
Mailing address:
  • Phone: 573-768-3220
  • Fax: 573-768-3221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHERRY CLOUSE DAY
Title or Position: VP-FINANCE MERCY CAH
Credential:
Phone: 417-820-8439