Healthcare Provider Details

I. General information

NPI: 1477505816
Provider Name (Legal Business Name): MERCY HOSPITAL SPRINGFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 S FREMONT AVE SUITE 5200
SPRINGFIELD MO
65804-2239
US

IV. Provider business mailing address

1570 W BATTLEFIELD ST SUITE 110
SPRINGFIELD MO
65807-4174
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-7099
  • Fax: 417-820-8178
Mailing address:
  • Phone: 417-820-5550
  • Fax: 417-820-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number005306
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number005306
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number005306
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

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