Healthcare Provider Details

I. General information

NPI: 1770528382
Provider Name (Legal Business Name): MERCY HOSPITAL SPRINGFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W ELDON ST
SAINT JAMES MO
65559-1903
US

IV. Provider business mailing address

105 W ELDON ST
SAINT JAMES MO
65559-1903
US

V. Phone/Fax

Practice location:
  • Phone: 573-265-8901
  • Fax: 573-265-8310
Mailing address:
  • Phone: 573-265-8901
  • Fax: 573-265-8310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2011020757
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2011020757
License Number StateMO

VIII. Authorized Official

Name: MR. PATRICK BERRY
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 314-628-5606