Healthcare Provider Details

I. General information

NPI: 1437596160
Provider Name (Legal Business Name): MERCY HOSPITAL LEBANON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 S PINE ST
RICHLAND MO
65556-7393
US

IV. Provider business mailing address

904 S PINE ST
RICHLAND MO
65556-7393
US

V. Phone/Fax

Practice location:
  • Phone: 573-765-2956
  • Fax:
Mailing address:
  • Phone: 573-765-2956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT REYNOLDS
Title or Position: VICE PRESIDENT-FINANCE
Credential:
Phone: 417-820-2818