Healthcare Provider Details

I. General information

NPI: 1558430090
Provider Name (Legal Business Name): MERCY HOSPITAL SPRINGFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25376 STATE HIGHWAY 39 SUITE 203
SHELL KNOB MO
65747-7343
US

IV. Provider business mailing address

1570 W BATTLEFIELD STREET SUITE 110
SPRINGFIELD MO
65807-4163
US

V. Phone/Fax

Practice location:
  • Phone: 417-858-2933
  • Fax: 417-858-2877
Mailing address:
  • Phone: 417-820-5550
  • Fax: 417-820-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number15928HH
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier580701001
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

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