Healthcare Provider Details

I. General information

NPI: 1932176401
Provider Name (Legal Business Name): MERCY CLINIC HEART AND VASCULAR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S NEW BALLAS RD SUITE 2015
SAINT LOUIS MO
63141-8253
US

IV. Provider business mailing address

625 S NEW BALLAS RD SUITE 2015
SAINT LOUIS MO
63141-8253
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-1700
  • Fax: 214-251-1701
Mailing address:
  • Phone: 314-251-1700
  • Fax: 314-251-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: KERRY DUNGER
Title or Position: EXECUTIVE DIRECTOR - FINANCE
Credential:
Phone: 314-364-3707